Coronary artery bypass grafting after acute ST-elevation myocardial infarction |
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| Affiliation: | 1. The Section of Cardiology, Baylor College of Medicine, Houston, TX, USA;2. Health Research Institute of the Balearic Islands, Hospital Son Espases, Palma, Spain;3. Faculty of Medicine and Health Technology, University of Tampere, Finnish Cardiovascular Research Center, Tampere, Finland;4. Heart Hospital, Tampere University Hospital, Tampere, Finland;5. Servicios Sanitarios del Area de Salud de El Heirro, Valle del Golfo Health Center, C/Marcos Luis Barrera, 1.38911 Frontera, El Hierro, Spain;6. International Laser Center, Institute of Pathophysiology, Medical School, Comenius University, Bratislava, Slovak Republic;7. Clinica y Maternidad Suizo Argentina and De Los Arcos Sanatorio, Buenos Aires, Argentina;8. Division of Cardiology, University of Rochester Medical Center, Rochester, NY, USA;9. Institute of Health and Wellbeing, University of Glasgow, Electrocardiology Section, Royal Infirmary, Glasgow, Scotland, UK;10. Internal Medicine Department, School of Medicine, Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil;11. Department of Electrocardiology, Medical University of Lodz, Poland;12. Cardiovascular Research Foundation, Cardiovascular ICCC- Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain |
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| Abstract: | ObjectivesThe study objectives were to describe the trends and outcomes of isolated coronary artery bypass grafting after ST-elevation myocardial infarction using a nationwide database.MethodsWe queried the 2002-2016 National Inpatient Sample database for hospitalized patients with ST-elevation myocardial infarction who underwent isolated coronary artery bypass grafting. We report temporal trends, predictors, and outcomes of coronary artery bypass grafting in the early (2002-2010) and recent (2011-2016) cohorts.ResultsOf 3,347,470 patients hospitalized for ST-elevation myocardial infarction, 7.7% underwent isolated coronary artery bypass grafting. The incidence of isolated coronary artery bypass grafting after ST-elevation myocardial infarction decreased over time (9.2% in 2002 vs 5.5% in 2016, Ptrend < .001), whereas perioperative crude in-hospital mortality did not change (5.1% in 2002 vs 4.2% in 2016, Ptrend = .66), coinciding with an increase in the burden of comorbidities. There was an increase in performing isolated coronary artery bypass grafting on hospitalization day 3 or more, as well as an increase in the use of mechanical support devices and precoronary artery bypass grafting percutaneous coronary intervention. In the early cohort, isolated coronary artery bypass grafting on days 1 and 2 was associated with higher in-hospital mortality. In the recent cohort, coronary artery bypass grafting on day 2 had similar in-hospital mortality compared with day 3 or more and lower rates of acute kidney injury, ischemic stroke, ventricular arrhythmia, and length of hospital stay.ConclusionsIn this nationwide analysis, there has been a decline in the use of isolated coronary artery bypass grafting after ST-elevation myocardial infarction. Isolated coronary artery bypass grafting on day 1 was performed in sicker patients and was associated with higher in-hospital mortality than coronary artery bypass grafting performed on day 3 or more. In the recent cohort, isolated coronary artery bypass grafting on day 2 had similar in-hospital mortality compared with day 3 or more. |
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