# A Comprehensive Review of Acute Coronary Syndrome and Bypass Surgery: Recent Advances, Timing, and Indicative Considerations

## TL;DR

This paper reviews recent advances in managing acute coronary syndrome with bypass surgery, focusing on optimal timing and patient selection.

## Contribution

The study provides a comprehensive analysis of CABG timing and outcomes in ACS patients, addressing ongoing clinical debates.

## Key findings

- 17 studies focused on the effects of surgical timing in acute coronary syndrome.
- 8 studies compared outcomes of CABG and PCI in ACS patients.
- Early surgery reluctance based on poor outcomes may be misleading.

## Abstract

Background: Acute coronary syndrome (ACS) continues to be a major contributor to morbidity and mortality worldwide. While percutaneous coronary interventions (PCIs) have significantly evolved, coronary artery bypass grafting (CABG) has retained a role in emergency revascularization. Nevertheless, ongoing debate persists about how to select candidates for surgery, when to operate, and which surgical techniques offer the greatest safety and efficacy. Methods: A comprehensive literature search was conducted, yielding 2302 records, of which 25 studies met predefined screening criteria and were included for detailed analysis. Given that timing remains one of the most controversial issues in the management of ACS, our primary aim was to determine the optimal timing for CABG in this patient population. Additionally, we examined how preoperative antiplatelet therapy and the presence of cardiogenic shock influence clinical outcomes, and what revascularization strategy may be most appropriate for these patients. Results: Of the 2302 initially identified studies, 25 were selected for a detailed analysis, supplemented by 28 additional key references. Among the included studies, 17 focused primarily on the effects of surgical timing and 8 on comparisons between the outcomes of CABG and PCI. The analysis comprised 15 database or multicentre retrospective cohort studies, 8 single-centre retrospective studies, and 2 prospective investigations. Conclusion and limitations: Although the topic of non-elective coronary surgery has been with us for several decades, a number of inherent biases hinder thorough statistical investigation in this complex population. Although a number of contradictory findings hinder drawing simple conclusions, being reluctant to perform early surgery solely based on poorer unfiltered outcomes might miss a point.