Emergency Coronary Artery Bypass Surgery for Acute Coronary Syndromes

Unstable angina, nontransmural myocardial infarction, and transmural myocardial infarction all represent variable degrees of coronary insufficiency. Nontransmural and transmural myocardial infarction result in contractile impairment and cellular necrosis. Myocardial infarction is then a progressive process that recruits cell population until the process is terminated by a myocardial scar and/or complicated by continued ischemia, heart failure, or mortality. Nontransmural myocardial infarction is commonly associated with high-grade stenoses that appears to be progressive with time. Additionally these patients have a high prevalence of multivessel disease and approximately 9% may have left main coronary artery disease.1 Transmural myocardial infarction is characterized by a high prevalence of total coronary occlusion that gradually decreases with time.2