Short- and long-term outcomes of ST-segment elevation myocardial infarction treated with CABG: a population-based
Emmi Saura1,2, Vesa Anttila2,3, Jarmo Gunn4,5
1Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland.
Insights
Outcomes for ST-elevation myocardial infarction (STEMI) patients treated with coronary artery bypass grafting (CABG) are acceptable. In-hospital mortality has decreased, and secondary prevention medication use has increased post-CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Public Health
Background:
- ST-elevation myocardial infarction (STEMI) is a critical condition requiring timely intervention.
- Coronary artery bypass grafting (CABG) is a major surgical treatment for severe coronary artery disease.
- Understanding outcomes for STEMI patients undergoing CABG is crucial for clinical practice and healthcare policy.
Purpose of the Study:
- To investigate the in-hospital and long-term outcomes of patients with STEMI treated with CABG surgery.
- To analyze trends in mortality and the use of secondary preventive medications over time.
Main Methods:
- Retrospective nationwide cohort study of 1069 STEMI patients treated with CABG in Finland (2004-2018).
- Primary outcomes included all-cause mortality and usage of evidence-based secondary preventive medication.
- Median follow-up was 6.4 years.
Main Results:
- In-hospital mortality was 10.0% and decreased significantly over the study period.
- Cumulative 10-year mortality was 38.3%.
- Factors associated with mortality included age, diabetes, renal disease, and graft type. Secondary preventive medication use, including statins and beta-blockers, increased over time.
Conclusions:
- Contemporary in-hospital and long-term outcomes for CABG-treated STEMI patients are acceptable.
- There has been a notable decrease in in-hospital mortality and an increase in secondary prevention medication use in recent years.
- These findings highlight improvements in care for STEMI patients undergoing CABG.
Objectives:
To investigate the outcomes of patients with ST-elevation myocardial infarction (STEMI) who were treated with coronary artery bypass grafting (CABG) surgery.
Design:
Retrospective nationwide cohort study.
Setting:
Patients with STEMI in Finland who were treated with CABG between January 2004 and December 2018.
Participants:
1069 patients (mean age: 66.4, 21.4% women).
Primary Outcome Measure:
All-cause mortality (median follow-up 6.4 years) and usage of evidence-based secondary preventive medication early after CABG.
Results:
In-hospital mortality among the total cohort was 10.0%, with a significant decrease (p<0.0001) during the study period. Cumulative 10-year mortality was 38.3%. Age, diabetes, renal disease, early surgery, usage of only venous grafts and concomitant procedures were associated with in-hospital mortality in multivariable modelling. Age, cerebrovascular disease, diabetes, heart failure, peripheral vascular disease, rheumatic disease and venous-only grafts were associated with 10-year mortality. Statins and beta blockers were used by >90% of patients and ACE inhibitors/angiotensin II receptor blockers by 70% of patients after discharge from the hospital. The proportion of high-dose statin users increased from 33.1% in 2004-2008 to 63.1% in 2014-2018. ADP inhibitors were used by 29.0% of patients, but the proportion increased during the study.
Conclusions:
Contemporary in-hospital and long-term outcomes of CABG-treated patients with STEMI are acceptable. In-hospital mortality has decreased, and the usage of secondary prevention medications after CABG procedures has increased in recent years.
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