Coronary artery bypass grafting after acute ST-elevation myocardial infarction

• DOI: 10.1016/j.jtcvs.2021.03.081
• Publication Date: 2021-03-31T14:04:35Z
• Authors: Ayman Elbadawi; Mohammed Elzeneini; Islam Y. Elgendy; Michael Megaly; Mohamed Omer; Ernesto Jimenez; Ravi K. Ghanta; Emmanouil S. Bril...; Hani Jneid
• Keywords: Arrhythmias, Cardiac; 3. Good health; 03 medical and health sciences; Treatment Outcome; Percutaneous Coronary Intervention; 0302 clinical medicine; Risk Factors; Humans; ST Elevation Myocardial Infarction; Hospital Mortality; Coronary Artery Bypass; Anterior Wall Myocardial Infarction

The study objectives were to describe the trends and outcomes of isolated coronary artery bypass grafting after ST-elevation myocardial infarction using a nationwide database.We 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.Of 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.In 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.