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Myocardial Infarction Classification on Outcomes in Nonemergent Coronary Artery Bypass Grafting

Pey-Jen Yu1, Hugh A Cassiere1, Nina Kohn2

  • 1Department of Cardiovascular and Thoracic Surgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York.

The Annals of Thoracic Surgery
|July 25, 2015
PubMed

Insights

Patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) undergoing coronary artery bypass grafting (CABG) within one week showed similar early surgical outcomes, despite differing preoperative characteristics.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Clinical Outcomes Research

Background:

  • ST-elevation myocardial infarction (STEMI) patients generally have worse outcomes than non-ST-elevation myocardial infarction (NSTEMI) patients.
  • Differences in outcomes for STEMI vs. NSTEMI patients undergoing coronary artery bypass grafting (CABG) are not well-established.
  • This study investigates early postoperative outcomes in patients undergoing nonemergent CABG within one week of STEMI versus NSTEMI.

Purpose of the Study:

  • To compare postoperative outcomes of patients undergoing nonemergent coronary artery bypass grafting (CABG) within 1 week after a STEMI versus an NSTEMI.
  • To determine if STEMI classification impacts early surgical outcomes in patients requiring subsequent CABG.
  • To inform surgical decision-making regarding the timing of CABG relative to myocardial infarction type.

Main Methods:

  • Retrospective analysis of patients undergoing isolated CABG between 1 and 7 days post-myocardial infarction (MI) from 2008-2012.
  • Comparison of postoperative outcomes, including mortality and composite morbidity, between STEMI and NSTEMI cohorts.
  • Statistical analysis to identify significant differences in outcomes between the two groups.

Main Results:

  • Of 446 patients, 122 (27.3%) had STEMI. STEMI patients were younger with less hypertension but poorer overall cardiac status and lower incidence of congestive heart failure.
  • No significant differences were observed in mortality, major complication rates, ICU length of stay, or hospital length of stay between STEMI and NSTEMI groups.
  • Despite preoperative differences, early surgical outcomes were comparable between STEMI and NSTEMI patients undergoing CABG within one week of MI.

Conclusions:

  • Early surgical outcomes after coronary artery bypass grafting (CABG) within one week of myocardial infarction (MI) are similar for ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) patients.
  • Preoperative characteristics and MI pathophysiology differ between STEMI and NSTEMI patients undergoing CABG.
  • MI classification should not influence the surgical decision-making process for these patients.
Abstract

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