Risk factors and outcomes of acute compartment syndrome after coronary artery bypass grafting: a matched case-control study

Acute compartment syndrome (ACoS) following coronary artery bypass grafting (CABG) is a rare yet fatal complication with unclear risk factors and clinical characteristics. This study aimed to analyze the incidence, risk factors, and clinical outcomes of ACoS after CABG. A retrospective analysis was conducted on 77,810 patients who underwent CABG at Beijing Anzhen Hospital between January 2007 and October 2024. Using a 1:4 matched design, clinical data from 20 postoperative patients with ACoS (ACoS group) and 80 patients without ACoS (NACoS group) were compared.The risk factors of ACoS after CABG were identified by logistic regression analysis. The incidence of ACoS after CABG was 0.026% (20/77,810). The ACoS group had a significantly lower average body mass index (BMI) compared to the NACoS group (24.54 vs. 26.39, P = 0.018). Utilization rates of intra-aortic balloon pump (IABP) (80% vs. 21.25%) and extracorporeal membrane oxygenation (ECMO) (55% vs. 3.75%) were significantly higher in the ACoS group (P < 0.001). Mean arterial pressure (MAP) at 18 h (72.58 vs. 79.42 mmHg, P = 0.004) and 24 h postoperatively (73.33 vs. 78.33 mmHg, P = 0.004) was significantly lower in the ACoS group. ACoS occurred in the lower limb with great saphenous vein (GSV) harvesting in 75% of cases, with a markedly elevated median postoperative myoglobin peak (3970 vs. 237 ng/mL, P < 0.001). Mortality reached 100% in conservatively treated patients, while survival rate with fasciotomy was 58.3%. ACoS after CABG is associated with lower BMI, use of circulatory assist devices (IABP and ECMO), and postoperative hypotension. Clinicians should remain vigilant for patients who are high-risk and optimize intervention strategies. 1. ACoS is rare but fatal post-CABG, occurring in 0.026% of cases, with a 100% mortality rate in conservatively treated patients. 2. Lower BMI, circulatory assist devices (IABP, ECMO), and postoperative hypotension are major risk factors for ACoS. 3. Saphenous vein harvesting is linked to ACoS, with 75% of cases occurring in the graft donor limb. 4. Postoperative MAP decline beyond 12 h may serve as an early predictor of ACoS development. 5. Early fasciotomy improves survival (58.3%), highlighting the need for prompt diagnosis and intervention.