Related Experiment Video
Updated: Dec 18, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Long-Term Outcomes in ST Elevation Myocardial Infarction Patients Undergoing Coronary Artery Bypass Graft Versus
Ilan Merdler1, Mustafa Gabarin1, Itamar Loewenstein1
1Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Early coronary artery bypass grafting (CABG) for ST-elevation myocardial infarction (STEMI) is rare and associated with higher mortality compared to percutaneous coronary intervention (PCI). Surgery after 72 hours may reduce risk in STEMI patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) is infrequently used for primary reperfusion in ST-elevation myocardial infarction (STEMI), with primary percutaneous coronary intervention (PCI) being the dominant strategy.
- CABG is estimated to be performed in less than 5% of STEMI cases, highlighting a shift in treatment paradigms.
Purpose of the Study:
- To compare the early and long-term outcomes of patients with STEMI who underwent early coronary artery bypass grafting (CABG) versus primary percutaneous coronary intervention (PCI).
Main Methods:
- A retrospective cohort study analyzed 1660 patients hospitalized with acute STEMI between January 2008 and June 2016.
- Outcomes were assessed for patients undergoing primary PCI compared to those receiving early CABG (within 30 days) as reperfusion therapy.
Main Results:
- Out of 1660 STEMI patients, only 38 (2.3%) underwent CABG within 30 days.
- Unadjusted 30-day mortality was higher in the CABG group (7.5%) than the PCI group (3.3%), though not statistically significant.
- Long-term mortality rates showed similar trends (22% vs. 14%), with multivariate analysis revealing no significant difference in long-term mortality risk between the groups. Patients undergoing CABG after 72 hours survived past 2 years.
Conclusions:
- Early CABG is performed in a small fraction of STEMI patients and is associated with worse outcomes compared to PCI.
- The timing of CABG may be critical, with surgery performed beyond 72 hours potentially linked to reduced risk in this high-risk population.
Background:
Coronary artery bypass grafting (CABG) for primary reperfusion in patients with ST elevation myocardial infarction (STEMI) has largely been superseded byf primary percutaneous coronary intervention (PCI) and is estimated to be performed in ≤ 5% of STEMI cases.
Objectives:
To compare early CABG (within 30 days following admission) and primary PCI outcomes following STEMI.
Methods:
We analyzed a retrospective cohort of patients hospitalized with acute STEMI for early reperfusion therapy between January 2008 and June 2016. Short- and long-term outcomes were assessed for patients with STEMI undergoing primary PCI vs. early CABG as reperfusion therapy.
Results:
The study comprised 1660 STEMI patients, 38 of whom (2.3%) underwent CABG within 30 days of presentation. Unadjusted 30-day mortality was more than twice as high in the CABG group (7.5%) than in the PCI group (3.3%); however, it did not reach statistical significance. Similar results were demonstrated for mortality rates beyond 30 days (22% vs. 14%, P = 0.463). All patients undergoing CABG beyond 72 hours following admission survived past 2 years. Multivariate analysis found no differences between the two groups in long-term mortality risk. propensity score matched long-term mortality comparison (30 days-2 years) yielded a 22% mortality rate in the CABG groups compared with 14% in the PCI group (P < 0.293).
Conclusions:
Early CABG was performed in only a minority of STEMI patients. This high-risk patient population demonstrated worse outcomes compared to patients undergoing PCI. Performing surgery beyond 72 hours following admission may be associated with lower risk.
More Related Videos
09:12Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:27Peripheral Artery Disease III: Interprofessional Care