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CORONARY ARTERY BYPASS GRAFT SURGERY AFTER ACUTE ST ELEVATION MYOCARDIAL INFARCTION: HOW EARLY IS TOO EARLY?
99 JACC March 21, 2017 Volume 69, Issue 11
Acute and Stable Ischemic Heart Disease CORONARY ARTERY BYPASS GRAFT SURGERY AFTER ACUTE ST ELEVATION MYOCARDIAL INFARCTION: HOW EARLY IS TOO EARLY? Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 3:45 p.m.-4:30 p.m. Session Title: Revascularization and Myocardial Preservation in Acute and Stable Ischemic Heart Disease Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy Presentation Number: 1165-307 Authors: Gbolahan Ogunbayo, Odunayo Olorunfemi, Ayman Elbadawi, Deola Saheed, Adrian Messerli, University of Kentucky, Lexington, KY, USA, Rochester General Hospital, Rochester, NY, USA
Background: The optimal timing of coronary artery bypass graft surgery (CABG) in patients presenting with acute ST elevation myocardial infarction (STEMI) is unclear.
Methods: We reviewed the Nationwide Inpatient Survey database for all cases with a primary diagnosis of STEMI who underwent CABG within the same admission from 2004 to 2013. We described the characteristics and outcomes between patients that had immediate (within 24 hours of admission) and delayed CABG (after 24 hours of admission). Our outcomes of interest were mortality, length of stay and hospital costs. Results: Of the 32,100 patients who met the inclusion criteria for our study, 6,683 had immediate CABG while 25,417 had delayed CABG. Their mean age was 63.5±11.5 and 74.5% were male. A significantly higher proportion of patients in the immediate CABG group had anterior wall STEMI (41.6% vs. 33.2%, p<.001). More coronary stents were deployed in the delayed CABG arm (4.4% vs. 2.5%, p<.001). Patients that received some form of percutaneous coronary intervention were more likely to undergo delayed CABG (20.8% VS. 19.3%, P=.007). Patients in the immediate CABG group developed more cardiogenic shock, cardiac tamponade, respiratory failure, acute renal failure and cardiac arrest, and were more likely to be intubated, undergo hemodialysis, or be treated with intra-aortic balloon counterpulsation or extracorporeal membrane oxygenation (p<.001 for all interactions, p=.001 for hemodialysis). Mortality was significantly higher in the immediate CABG group (9.7% vs. 4.8%, p<.001). Although the length of stay in the delayed CABG group was significantly longer (12±10 vs. 10±10), there was no significant difference in the average hospital costs between both groups. Females (OR=1.37 95% CI 1.14-1.64, p=.001) and patients over 65 years (OR=2.53, 95% CI 2.13-3.01) had significantly higher odds for mortality in the immediate CABG group. Conclusions: In patients with acute STEMI, there was significant increase in mortality among patients that underwent bypass grafting within 24 hours of their event. Females and patients over 65 years in this group had significant odds for mortality.
Acute and Stable Ischemic Heart Disease CORONARY ARTERY BYPASS GRAFT SURGERY AFTER ACUTE ST ELEVATION MYOCARDIAL INFARCTION: HOW EARLY IS TOO EARLY? Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 3:45 p.m.-4:30 p.m. Session Title: Revascularization and Myocardial Preservation in Acute and Stable Ischemic Heart Disease Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy Presentation Number: 1165-307 Authors: Gbolahan Ogunbayo, Odunayo Olorunfemi, Ayman Elbadawi, Deola Saheed, Adrian Messerli, University of Kentucky, Lexington, KY, USA, Rochester General Hospital, Rochester, NY, USA
Background: The optimal timing of coronary artery bypass graft surgery (CABG) in patients presenting with acute ST elevation myocardial infarction (STEMI) is unclear.
Methods: We reviewed the Nationwide Inpatient Survey database for all cases with a primary diagnosis of STEMI who underwent CABG within the same admission from 2004 to 2013. We described the characteristics and outcomes between patients that had immediate (within 24 hours of admission) and delayed CABG (after 24 hours of admission). Our outcomes of interest were mortality, length of stay and hospital costs. Results: Of the 32,100 patients who met the inclusion criteria for our study, 6,683 had immediate CABG while 25,417 had delayed CABG. Their mean age was 63.5±11.5 and 74.5% were male. A significantly higher proportion of patients in the immediate CABG group had anterior wall STEMI (41.6% vs. 33.2%, p<.001). More coronary stents were deployed in the delayed CABG arm (4.4% vs. 2.5%, p<.001). Patients that received some form of percutaneous coronary intervention were more likely to undergo delayed CABG (20.8% VS. 19.3%, P=.007). Patients in the immediate CABG group developed more cardiogenic shock, cardiac tamponade, respiratory failure, acute renal failure and cardiac arrest, and were more likely to be intubated, undergo hemodialysis, or be treated with intra-aortic balloon counterpulsation or extracorporeal membrane oxygenation (p<.001 for all interactions, p=.001 for hemodialysis). Mortality was significantly higher in the immediate CABG group (9.7% vs. 4.8%, p<.001). Although the length of stay in the delayed CABG group was significantly longer (12±10 vs. 10±10), there was no significant difference in the average hospital costs between both groups. Females (OR=1.37 95% CI 1.14-1.64, p=.001) and patients over 65 years (OR=2.53, 95% CI 2.13-3.01) had significantly higher odds for mortality in the immediate CABG group. Conclusions: In patients with acute STEMI, there was significant increase in mortality among patients that underwent bypass grafting within 24 hours of their event. Females and patients over 65 years in this group had significant odds for mortality.