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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Early versus delayed coronary artery bypass graft surgery for patients with non-ST elevation myocardial infarction
Le Dung Ha1, Gbolahan Ogunbayo, Ayman Elbadawi
1aDepartment of Internal Medicine, Rochester General Hospital, Rochester, New York bUniversity of Kentucky, Lexington, Kentucky, USA.
Insights
Early coronary artery bypass graft surgery (CABG) within 48 hours of admission shows no significant increase in in-hospital mortality compared to delayed CABG. This finding is crucial for patients with non-ST elevation myocardial infarction and multivessel disease.
Area of Science:
- Cardiology
- Cardiac Surgery
- Health Services Research
Background:
- Coronary artery bypass graft surgery (CABG) offers benefits for non-ST elevation myocardial infarction with multivessel disease.
- Optimal timing for CABG in these patients remains uncertain.
- This study investigates early (<48h) versus delayed (>48h) CABG outcomes.
Purpose of the Study:
- To compare clinical outcomes between early and delayed CABG in acute myocardial infarction patients.
- To determine if early CABG increases in-hospital mortality risk.
- To identify risk factors for mortality in CABG patients.
Main Methods:
- Utilized the Nationwide Inpatient Sample database (USA).
- Identified acute myocardial infarction patients undergoing CABG using ICD 9-DM codes.
- Performed propensity score-matching for 24 confounders to compare early (<48h) vs. delayed (>48h) CABG groups.
Main Results:
- Analyzed 31,969 patients; 1555 matched pairs for early vs. delayed CABG.
- No significant difference in mortality (2% early vs. 1.8% delayed, P=0.695).
- Comparable rates of hemorrhage, shock, and organ complications; age >70, cardiogenic shock, and mechanical support were mortality risk factors.
Conclusions:
- CABG within 48 hours of admission is not associated with increased in-hospital mortality.
- Early CABG is a safe option compared to delayed CABG in propensity-matched patients.
- Age, cardiogenic shock, and mechanical support significantly impact mortality risk.
Background:
Although coronary artery bypass graft surgery (CABG) has been proven to have mortality and morbidity benefits in patients with non-ST elevation myocardial infarction and multivessel disease, the appropriate timing of this procedure remains unclear. Therefore, we proposed a propensity score-matched analysis comparing the clinical outcomes between patients who underwent CABG within the first 48 h of admission (early CABG) and patients who underwent CABG after 48 h of admission (delayed CABG).
Patients And Methods:
Using the largest inpatient care database in the USA, the Nationwide Inpatient Sample, we identified patients with a primary diagnosis of acute myocardial infarction using the ICD 9-DM diagnosis codes. We then performed propensity score-matching analysis to control for 24 possible confounders.
Results:
We identified 31 969 patients in the Nationwide Inpatient Sample database with a primary diagnosis of acute myocardial infarction who underwent CABG. The mean age of the cohort was 64.5±11.5 years and 33.4% were female. After performing propensity-matching analysis, we obtained a subset of 1555 patients in each group, with a mean age of 64.7±10.1 years; the male to female ratio was ~4 : 1. The incidence of hemorrhage, shock, and cardiac, pulmonary, and renal complications was comparable between the two groups. The incidence of mortality was not statistically significant between the two groups (2% in the early CABG vs. 1.8% in the delayed CABG, P=0.695). The mortality risk factors were as follows: age more than 70 years [odds ratio (OR): 3.42, 95% confidence interval (CI): 1.85-6.34, P<0.001]; cardiogenic shock (OR: 3.22, 95% CI: 1.35-7.67, P=0.008); and mechanical circulatory support with balloon counterpulsation (OR: 2.93, 95% CI: 1.45-5.90, P=0.003).
Conclusion:
CABG performed within 48 h of admission does not significantly increase the risk for in-hospital mortality compared with undergoing the procedure after 48 h of admission in propensity-matched patients.
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