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. 2024 May 23:20:40-48.
doi: 10.1016/j.xjon.2024.05.008. eCollection 2024 Aug.

Timing of coronary artery bypass grafting after myocardial infarction influences late survival

Sri Harsha Patlolla  1 , Juan A Crestanello  1 , Hartzell V Schaff  1 , Alberto Pochettino  1 , John M Stulak  1 , Richard C Daly  1 , Kevin L Greason  1 , Joseph A Dearani  1 , Nishant Saran  1
Affiliations

Timing of coronary artery bypass grafting after myocardial infarction influences late survival

Sri Harsha Patlolla et al. JTCVS Open. .

Abstract

Objectives: The role of timing of coronary artery bypass grafting after acute myocardial infarction on early and late outcomes remains uncertain.

Methods: We reviewed 1631 consecutive adult patients who underwent isolated coronary artery bypass grafting with information on timing of acute myocardial infarction. Early and late mortality were compared between patients receiving coronary artery bypass grafting within 24 hours after acute myocardial infarction, between 1 and 7 days after acute myocardial infarction, and more than 7 days after acute myocardial infarction. Sensitivity analyses were performed in subgroups of patients with ST-segment elevation myocardial infarction or non-ST-segment elevation myocardial infarction, and other high-risk groups.

Results: A total of 124 patients (5.7%) underwent coronary artery bypass grafting within 24 hours, 972 patients (51.2%) received coronary artery bypass grafting between 1 and 7 days after acute myocardial infarction, and 535 patients (43.2%) underwent coronary artery bypass grafting more than 7 days after acute myocardial infarction. Overall operative mortality was 2.7% with comparable adjusted early mortality among 3 groups. Over a median follow-up of 13.5 years (interquartile range, 8.9-17.1), compared with patients receiving coronary artery bypass grafting between 1 and 7 days after acute myocardial infarction, those receiving coronary artery bypass grafting at 7 days had greater adjusted risk for late overall mortality (hazard ratio, 1.39, 95% CI, 1.16-1.67; P < .001), whereas those receiving coronary artery bypass grafting within 24 hours had comparable risk of late overall mortality (hazard ratio, 1.12, 95% CI, 0.86-1.47; P = .39). Timing of coronary artery bypass grafting was associated with late mortality in patients with non-ST-segment elevation myocardial infarction (patients receiving coronary artery bypass grafting at >7 days had a higher risk of late mortality [hazard ratio, 1.38, 95% CI, 1.14-1.67, P < .001] compared with those receiving coronary artery bypass grafting between 1 and 7 days), but not in patients with ST-segment elevation myocardial infarction.

Conclusions: Early revascularization through coronary artery bypass grafting within 7 days during the same hospitalization appears beneficial, especially for patients presenting with non-ST-segment elevation myocardial infarction.

Keywords: acute myocardial infarction; coronary artery bypass grafting; survival; timing.

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Conflict of interest statement

The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

None
Long-term mortality risk after CABG in patients with STEMI and NSTEMI.
Figure 1
Figure 1
Kaplan–Meier estimate of survival comparing patients undergoing CABG within 24 hours, between 1 and 7 days, and more than 7 days after AMI. CABG, Coronary artery bypass grafting; AMI, acute myocardial infarction.
Figure 2
Figure 2
Forest plot showing long-term mortality risk in STEMI and NSTEMI cohorts based on timing of CABG. STEMI, ST-Segment elevation myocardial infarction; NSTEMI, non–ST-segment elevation myocardial infarction; CABG, coronary artery bypass grafting.
None
See this image and copyright information in PMC

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