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Published on: March 27, 2018
Coronary Artery Bypass Grafting Following ST Elevation Myocardial Infarction Outcomes Are Associated with Time to
Joshua G Crane1, Jaimin Trivedi1, Toyokazu Endo1
1Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY 40202, United States.
Insights
Timing coronary artery bypass grafting (CABG) after ST-elevation myocardial infarction (STEMI) impacts outcomes. Performing CABG 2-15 days post-STEMI is associated with the lowest in-hospital mortality risk.
Area of Science:
- Cardiology
- Cardiac Surgery
- Health Services Research
Background:
- ST-elevation myocardial infarction (STEMI) is a critical condition requiring timely intervention.
- Coronary artery bypass grafting (CABG) is performed in 5-10% of STEMI patients during the same hospital admission.
- The optimal timing for CABG after STEMI is not well-defined, influencing patient outcomes.
Purpose of the Study:
- To analyze the impact of time from STEMI to CABG on operative mortality, morbidity, length of hospital stay, and cost.
- To identify the optimal timing window for performing CABG after STEMI to minimize adverse events.
Main Methods:
- Utilized the Healthcare Cost and Utilization Project (HCUP) database from 2016-2022.
- Analyzed 11,974 STEMI patients who underwent CABG during the same hospitalization.
- Grouped patients by time from STEMI to CABG: <48 hours, 2-7 days, 8-15 days, and ≥16 days.
- Compared demographics, characteristics, mortality, length of stay, and cost using univariable and multivariable logistic regression.
Main Results:
- In-hospital mortality was highest for CABG performed <48 hours (6%) and ≥16 days (5%) post-STEMI.
- Length of stay and costs were significantly greater for patients undergoing CABG ≥16 days after STEMI.
- Performing CABG 2-7 days after STEMI was associated with decreased in-hospital mortality (OR 0.585).
Conclusions:
- The optimal window for post-STEMI CABG is between 2 and 15 days, offering the lowest in-hospital mortality risk.
- Early (<48 hours) or delayed (≥16 days) CABG after STEMI is associated with increased mortality.
- This study provides evidence for optimizing surgical timing to improve outcomes for STEMI patients requiring CABG.
Objectives:
Approximately 5%-10% of ST-segment elevation myocardial infarction (STEMI) patients will undergo coronary artery bypass grafting (CABG) during the same hospital admission. In this study, we analyse the time from STEMI to CABG and its impact on operative mortality, morbidity, hospital stay, and cost.
Methods:
The Healthcare Cost and Utilization Project (HCUP) was reviewed for STEMI patients who underwent CABG in the same hospitalization from 2016 to 2022. Patients were grouped by time from STEMI to CABG: <48 hours, 2-7 days, 8-15 days, and ≥16 days. Demographics, characteristics, mortality, length of stay, and cost were compared with univariable analysis. Multivariable logistic regression identified risk factors for in-hospital mortality.
Results:
HCUP database identified 11 974 patients who underwent CABG following STEMI: 4882 < 48 hours (41%), 6110 in 2-7 days (51%), 896 in 8-15 days (7%), and 86 ≥ 16 days in (1%). Mortality was greatest when CABG performed <48 hours (6%) and ≥16 days (5%) compared to other groups 3% (2-7 days) vs 3% (8-15 days), P <.01. Length of stay was greatest in ≥16 days (30 days) compared to other groups 7 days (<48 hours) vs 10 days (2-7 days) vs 17 days (8-15 days), P < .01. Costs were also greatest in the ≥16 days ($108 400) compared to other groups ($50 400 [<48 hours] vs $55 300 [2-7 days] vs $73 600 [8-15 days], P < .01). Multivariable regression identified 2-7 days STEMI to CABG decreased in-hospital mortality (odds ratio [OR] 0.585, CI95% 0.48-0.70).
Conclusions:
CABG performed 2-15 days from STEMI provided the lowest in-hospital mortality risk, offering a window for the safest post-STEMI CABG when appropriate.
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