Optimal Timing From Myocardial Infarction to Coronary Artery Bypass Grafting on Hospital Mortality
Elizabeth L Nichols1, Jock N McCullough2, Cathy S Ross1
1The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon.
Insights
Delaying coronary artery bypass grafting (CABG) after myocardial infarction (MI) for 1-7 days shows similar in-hospital death rates. However, performing CABG in less than 1 day post-MI is associated with higher mortality.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- The optimal timing for coronary artery bypass grafting (CABG) after myocardial infarction (MI) remains debated.
- Uncertainty exists regarding whether delaying CABG post-MI improves outcomes or unnecessarily consumes healthcare resources.
Purpose of the Study:
- To investigate the association between the time interval from myocardial infarction (MI) to coronary artery bypass grafting (CABG) and in-hospital mortality.
- To determine if early CABG after MI impacts patient survival.
Main Methods:
- Analysis of 3,060 isolated CABG patients with prior MI from the Northern New England Cardiovascular Disease Study Group registry (2008-2014).
- Comparison of in-hospital death rates based on MI-to-CABG timing: <1 day, 1-2 days, 3-7 days, and 8-21 days.
- Logistic regression was used to adjust for patient characteristics.
Main Results:
- In-hospital mortality was higher for CABG performed <1 day after MI (adjusted 5.4%) compared to other intervals.
- Adjusted in-hospital mortality rates were similar for CABG performed 1-2 days (1.8%), 3-7 days (1.7%), and 8-21 days (2.3%) after MI.
- Predicted mortality was similar for 1-day, 1-2 day, and 3-7 day intervals, but higher for the 8-21 day interval.
Conclusions:
- Performing CABG 1-2 days or 3-7 days after MI is associated with similar mortality rates, suggesting potential for reducing the MI-to-CABG interval.
- Operating within 1 day of MI was linked to a higher in-hospital mortality rate.
Background:
Whether delaying coronary artery bypass grafting (CABG) after myocardial infarction (MI) is associated with better outcomes or is an unnecessary use of health care resources is unclear. This study investigated the relationship between MI-to-CABG timing on in-hospital death.
Methods:
From the Northern New England Cardiovascular Disease Study Group (NNE) Cardiac Surgery Registry we identified 3,060 isolated CABG patients with prior MI from 2008 to 2014. We compared in-hospital death by MI-to-CABG timing of less than 1 day, 1 to 2 days, 3 to 7 days, and 8 to 21 days. We adjusted for patient characteristics using logistic regression.
Results:
Among patients with prior MI, CABG was performed within 1 day for 99 (3.2%), 1 to 2 days for 369 (12.1%), 3 to 7 days for 1,966 (64.3%), and 8 to 21 days for 626 (20.5%) patients. NNE-predicted mortality was similar for patients operated on within 1 day (1.8%), 1 to 2 days (1.8%), and 3 to 7 days (1.9%), but was higher for 8 to 21 days (2.4%) of MI. Crude in-hospital mortality was higher for those with MI-to-CABG time of less than 1 day (5.1%) compared with 1 to 2 days (1.6%), 3 to 7 days (1.6%), and 8 to 21 days (2.7%, p = 0.044). Adjusted in-hospital mortality remained high for less than 1 day (5.4%; 95% CI, 1.5% to 9.4%), and similar for 1 to 2 days (1.8%; 95% CI, 0.4% to 3.1%), 3 to 7 days (1.7%; 95% CI, 1.1% to 2.3%), and 8 to 21 days (2.3%; 95% CI, 1.2% to 3.3%) between MI and CABG.
Conclusions:
Patients operated on 1 to 2 days and 3 to 7 days after MI had a similar mortality rate, suggesting it may be possible to reduce the MI-to-CABG interval for some patients without sacrificing outcomes. Patients operated on within 1 day after MI had a higher mortality rate.
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