Inpatient vs Delayed Readmission for Coronary Artery Bypass Grafting After Non-ST Elevation Myocardial Infarction

Area of Science:

• Cardiology
• Cardiac Surgery
• Health Services Research

Background:

• The optimal timing for coronary artery bypass grafting (CABG) following non-ST-elevation myocardial infarction (NSTEMI) is not well-established.
• National practice patterns and outcomes for CABG timing after NSTEMI require further investigation.

Purpose of the Study:

• To assess national practice patterns and outcomes of CABG timing following NSTEMI.
• To compare inpatient versus delayed CABG strategies and analyze specific inpatient timing.

Main Methods:

• A retrospective analysis of Medicare beneficiaries (≥65 years) with NSTEMI undergoing diagnostic angiography (10/2016-10/2021).
• Propensity-score matching compared inpatient CABG with delayed elective CABG within three months.
• Primary endpoint: 30-day mortality; Secondary endpoint: 4-year survival. Logistic regression with natural cubic splines analyzed inpatient CABG timing (0-1, 2-3, 4-7, >7 days).

Main Results:

• Out of 704,638 patients, 27.1% underwent inpatient CABG and 2.3% had delayed elective CABG.
• Propensity-matched analysis showed lower 30-day mortality for delayed elective CABG (3.6% vs. 4.9%, p<0.001), but similar 4-year survival.
• Among discharged patients, 1.3% required urgent CABG (30-day mortality=6.3%), and 9.1% died within three months without revascularization.
• Inpatient CABG demonstrated optimal short-term outcomes when performed 2-4 days post-angiography.

Conclusions:

• Performing CABG 2-4 days after NSTEMI diagnosis is associated with optimal outcomes.
• While delayed elective CABG shows short-term survival benefits in selected patients, most NSTEMI patients benefit from inpatient revascularization due to risks of mortality and urgent intervention after discharge.