<p><strong>Purpose.</strong> The current myocardial re-vascularisation guidelines recommend that the coronary re-vascularisation of patients with high-risk non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) should be performed within 24 hours of admission. In real clinical practice; however, it is not always possible to keep coronary bypass surgery on schedule owing to various reasons. The aim of the current study, which presents cases of successful adherence to the surgical schedule, was to explore the need for 24/7 cardiac surgery services and to evaluate the outcomes of early (i.e. during the first 24 hours) coronary artery bypass grafting in 21 patients with high-risk NSTE-ACSs.<br /><strong>Methods.</strong> The medical records of patients undergone coronary bypass surgery for high-risk NSTE-ACSs within the first 24 hours of admission between 2017 and 2019 were retrospectively analysed.<br />Results. The mean age of the patients was 64.3 ± 5.6 years. Myocardial infarction was confirmed in 52.4 % (n = 11) of the subjects and progressive angina pectoris in 47.6 % (n = 10). The average waiting time to surgery was 17.8 ± 4.7 hours. Besides, 9.5 % (n = 2) of the cases, who had received dual antiplatelet therapy, exhibited a shorter waiting time to surgery. Patients were characterised by extremely severe clinical and angiographic status as follows: one in three had post-infarction cardiosclerosis and a first-degree family history of obesity; one in four had a history of percutaneous coronary intervention; and 61.9 % (n = 13) were found to have a left main coronary artery lesion, in 79.6 % (n = 10) of whom the left main coronary artery stenosis appeared to be greater than 80 %, necessitating the intra-aortic balloon counter-pulsation therapy in 33.3 % (n = 7) overall. Also, the mean cardiopulmonary bypass time turned out to be 88.6 ± 27.1 minutes, with an aortic clamping time of 47.6 ± 14.7 minutes. The in-hospital mortality rate was 14.3 % (n = 3), with cardiac and respiratory failure as well as mediastinitis (in one patient) being among the causes of adverse outcomes. So far, none of the studied cases has required re-sternotomy due to bleeding or perioperative acute cerebrovascular accident.<br /><strong>Conclusion.</strong> In high-risk NSTE-ACS patients with severe clinical and angiographic status, emergency coronary bypass surgery performed within 24 hours of admission may prove an effective treatment option that can help save patients’ lives through complete re-vascularisation.<br /><br />Received 31 March 2020. Revised 2 May2020. Accepted 16 May 2020.</p><p><strong>Funding:</strong> The study is supported as a part of the research program "Complete myocardial revascularization in patients with non-ST segment elevation acute coronary syndrome with coronary artery bypass grafting".</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and design: A.B. Nishonov<br />Data collection and analysis: A.B. Nishonov<br />Drafting the article: A.B. Nishonov, R.S. Tarasov<br />Critical revision of the article: S.V. Ivanov, T.S. Golovina, L.S. Barbarash<br />Final approval of the version to be published: A.B. Nishonov, R.S. Tarasov, S.V. Ivanov, T.S. Golovina, L.S. Barbarash</p>

The feasibility of dual antiplatelet therapy as early as possible in patients with ST-segment elevation acute coronary syndrome, where percutaneous coronary intervention is recommended, has been proven: it improves treatment outcomes by reducing the risk of adverse ischemic events, including stent thrombosis and myocardial infarction.This article provides a detailed analysis of the evidence data and current recommendations on the validity and timing of dual antiplatelet therapy for acute coronary syndrome. The emphasis is made on the controversy regarding the early dual antiplatelet therapy in non-ST-segment elevation acute coronary syndrome. The rationale for using dual antiplatelet therapy only after coronary angiography and determining the revascularization strategy is described, which should increase the accessibility of coronary artery bypass graft surgery for patients.

<p>This literature review provides the current evidence-based research regarding the role of intra-aortic balloon counterpulsation in the treatment of patients in various clinical situations. These include patients with acute coronary syndrome, complicated or uncomplicated by cardiogenic shock, accompanied by high-risk percutaneous coronary interventions, accompanying patients in need of coronary artery bypass surgery in various conditions as a ‘bridge’ to decision-making or treatment. Because the introduction of intra-aortic balloon counterpulsation into clinical practice, it has been the most common method of hemodynamic support in high-risk patients. The classical strategy for the treatment of acute myocardial infarction has evolved over the last decade from a thrombolysis scenario to a primary coronary revascularisation scenario, which resulted in a larger patient cohort. The currently available data, however, do not support the routine use of intra-aortic balloon counterpulsation by most of this population. Current studies have shown that the use of intra-aortic balloon counterpulsation did not lead to a decrease in 30-day mortality in patients with acute coronary syndrome and cardiogenic shock who received therapy with the strategy of early myocardial revascularisation as the planned primary goal. The expediency of using high-risk percutaneous coronary intervention as an accompanying method is ambiguous, whereas the use of the method as a ‘bridge’ to surgical myocardial revascularisation may be justified and requires additional research. The article provides the current recommendations for the treatment of patients. Research results and unresolved issues are being discussed.</p><p>Received 3 June 2020. Revised 4 August 2020. Accepted 24 August 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

The issue of the optimal timing of coronary artery bypass grafting (CABG) in acute coronary syndrome (ACS) remains controversial. It is known that on the one hand there will be a delay in revascularization, leading to recurrent myocardial infarction with irreversible cardiac dysfunction. On the other hand, there is an increased incidence of perioperative complications associated with surgery.This article provides a detailed analysis of the evidence base and current guidelines on the validity and timing of coronary artery bypass grafting in various types of ACS. The emphasis is made on the contradictions regarding the earlier implementation of the active strategy in non-ST segment elevation ACS. We describe problem of insufficient evidence base on optimal timing of CABG, comparison of outcomes of percutaneous coronary intervention (PCI) performed in the first 24 hours and open surgery for high-risk non-ST segment elevation ACS, as well as a number of organizational and clinical issues to ensure the surgery availability.

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