Timing of coronary artery bypass grafting after acute myocardial infarction may not influence mortality and readmissions
Valentino Bianco1, Arman Kilic2, Thomas G Gleason2
1Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa.
Insights
Timing of coronary artery bypass grafting (CABG) after acute myocardial infarction (AMI) does not significantly impact patient mortality or readmissions. Early CABG (less than 24 hours) showed higher initial mortality, but risk-adjusted analysis revealed no significant differences.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Coronary artery bypass grafting (CABG) is frequently delayed post-acute myocardial infarction (AMI) due to concerns about increased postoperative risks.
- Existing evidence on the optimal timing for CABG after AMI is limited, leading to varied clinical practices.
Purpose of the Study:
- To investigate the association between the timing of isolated CABG after AMI and postoperative outcomes, including mortality and readmission rates.
- To determine if early CABG (within 24 hours) versus delayed CABG (24 hours or more) affects patient outcomes.
Main Methods:
- A retrospective review of 2058 patients who underwent isolated CABG after AMI between 2011 and 2017 at a major academic medical center.
- Comparative analysis of outcomes between two cohorts: CABG less than 24 hours post-AMI and CABG 24 hours or more post-AMI.
- Risk adjustment using propensity scoring to account for baseline patient characteristics and comorbidities.
Main Results:
- Patients undergoing early CABG (less than 24 hours) had a higher unadjusted operative mortality (7.19% vs 3.79%).
- After risk adjustment, there was no statistically significant difference in operative mortality between the early and delayed CABG groups (4.15% vs 4.58%).
- New-onset atrial fibrillation was more frequent in the delayed CABG group, but major adverse cardiovascular and cerebrovascular event readmissions did not differ between groups.
Conclusions:
- The timing of isolated coronary artery bypass grafting after acute myocardial infarction is not significantly associated with differences in operative mortality or major adverse cardiovascular and cerebrovascular event readmissions after risk adjustment.
- These findings suggest that delaying CABG beyond 24 hours after AMI may not be necessary to improve patient safety, challenging traditional practice patterns.
Objective:
Coronary artery bypass grafting is often delayed after acute myocardial infarction to avoid an increase in postoperative morbidity and mortality. We hypothesized that the timing of coronary artery bypass grafting after acute myocardial infarction may not be consistently associated with postoperative outcomes.
Methods:
All patients who underwent isolated coronary artery bypass grafting at the University of Pittsburgh Medical Center from 2011 to 2017 after an acute myocardial infarction were reviewed. A comparative analysis for time from myocardial infarction presentation to coronary artery bypass grafting was performed with primary outcomes including all-cause mortality and readmission.
Results:
A total of 7048 patients underwent isolated coronary artery bypass grafting. Of these, 2058 patients had acute myocardial infarction with all relevant variables available for analysis. The study population was divided into 2 coronary artery bypass grafting timing cohorts, including less than 24 hours (n = 292) and 24 hours or more (n = 1766). Previous percutaneous coronary intervention, cardiogenic shock, and intra-aortic balloon pump were more prevalent in the less than 24 hours group. Operative mortality was significantly higher in the less than 24 hours cohort (7.19% vs 3.79%; P = .01). Diabetes mellitus, peripheral vascular disease, serum creatinine, age, chronic obstructive pulmonary disease, and immunosuppression were significant predictors (P < .05) of mortality. After risk adjustment with propensity scoring, there was no difference between time cohorts for operative mortality (4.15% vs 4.58%; P = .62). New-onset atrial fibrillation occurred more frequently in the 24 hours or more cohort. There was no difference between groups for the occurrence of major adverse cardiovascular and cerebrovascular event readmissions.
Conclusions:
After adjusting for baseline patient characteristics, there was no statistically significant difference between timing cohorts for mortality or major adverse cardiovascular and cerebrovascular event readmissions.
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