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Author Spotlight: Enhancing Coronary Artery Revascularization
05:25

Author Spotlight: Enhancing Coronary Artery Revascularization

Published on: September 15, 2023

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Coronary artery bypass grafting after acute ST-elevation myocardial infarction

Ayman Elbadawi1, Mohammed Elzeneini2, Islam Y Elgendy3

  • 1Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Tex; Section of Cardiology, Baylor School of Medicine, Houston, Tex.

The Journal of Thoracic and Cardiovascular Surgery
|May 1, 2021
PubMed

Insights

The use of isolated coronary artery bypass grafting after ST-elevation myocardial infarction has declined. While early grafting increased mortality, later grafting in recent years showed similar outcomes to delayed procedures.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Health Services Research

Background:

  • ST-elevation myocardial infarction (STEMI) is a critical condition requiring timely intervention.
  • Coronary artery bypass grafting (CABG) is a treatment option for STEMI, but its timing and outcomes are debated.
  • Understanding trends in isolated CABG post-STEMI is crucial for optimizing patient care.

Purpose of the Study:

  • To analyze temporal trends in isolated coronary artery bypass grafting (CABG) following ST-elevation myocardial infarction (STEMI).
  • To evaluate the predictors and in-hospital outcomes of isolated CABG in STEMI patients.
  • To compare outcomes between early and recent cohorts undergoing isolated CABG post-STEMI.

Main Methods:

  • Utilized the National Inpatient Sample database from 2002-2016.
  • Identified patients hospitalized with STEMI who underwent isolated CABG.
  • Compared outcomes between an early cohort (2002-2010) and a recent cohort (2011-2016).

Main Results:

  • Isolated CABG incidence post-STEMI decreased from 9.2% to 5.5% between 2002 and 2016.
  • In-hospital mortality for isolated CABG remained stable at approximately 4-5% despite increasing comorbidity burden.
  • Delayed CABG (day 3+) became more common; early CABG (day 1) in the recent cohort showed similar mortality to delayed procedures.

Conclusions:

  • Isolated CABG use after STEMI has declined nationwide.
  • Performing isolated CABG on hospitalization day 1 was associated with higher mortality, particularly in earlier years.
  • In recent years, isolated CABG on day 2 demonstrated comparable in-hospital mortality to procedures on day 3 or later, with improved secondary outcomes.
Abstract

Keywords:
CABGST-elevation myocardial infarctionrevascularization

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