Key result
CABG 2-7 days post-STEMI linked to ~42% lower in-hospital mortality versus earlier or later surgery.
Why the study?
Approximately 5–10% of STEMI patients undergo CABG during the same admission, but the impact of timing from STEMI to CABG on outcomes remains to be analyzed.
Does the timing of CABG following STEMI impact in-hospital mortality, length of stay, and costs?
Does the timing of CABG following STEMI impact in-hospital mortality, length of stay, and costs?
Delaying CABG to 2-15 days after STEMI is associated with the lowest in-hospital mortality risk compared to early (<48 hours) or very late (≥16 days) surgery.
May favor 2–7 day CABG timing post-STEMI to lower mortality; extends observational data but leaves optimal window open for RCTs.
OBJECTIVES Approximately 5–10% of STEMI patients will undergo coronary artery bypass grafting (CABG) during the same hospital admission. In this study, we analyze the time from STEMI to CABG and its impact on operative mortality, morbidity, hospital stay, and cost. METHODS The Healthcare Cost and Utilization Project (HCUP) was reviewed for STEMI patients who underwent CABG in the same hospitalization from 2016–2022. Patients were grouped by time from STEMI to CABG: <48 hours, 2–7 days, 8–15 days, and ≥16 days. Demographics, characteristics, mortality, length of stay, and cost were compared with univariable analysis. Multivariable logistic regression identified risk factors for in-hospital mortality. RESULTS HCUP database identified 11,974 patients who underwent CABG following STEMI: 4882 < 48 hours (41%), 6110 in 2–7 days (51%), 896 in 8–15 days (7%), and 86 ≥ 16 days in (1%). Mortality was greatest when CABG performed <48 hours (6%) and ≥16 days (5%) compared to other groups 3% (2–7 days) v 3% (8–15 days), p<.01. Length of stay was greatest in ≥ 16 days (30 days) compared to other groups 7 days (<48 hours) v 10 days (2–7 days) v 17 days (8–15 days), p < 0.01. Costs were also greatest in the ≥16 days ($108,400) compared to other groups ($50,400 (<48 hours) v $55,300 (2–7 days) v $73,600 (8–15 days), p < 0.01). Multivariable regression identified 2–7 days STEMI to CABG decreased in-hospital mortality (OR 0.585, CI95% 0.48–0.70). CONCLUSIONS CABG performed 2–15 days from STEMI provided the lowest in-hospital mortality risk, offering a window for the safest post-STEMI CABG when appropriate.
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Crane et al. (2026) studied this question. CABG performed 2–7 days after STEMI reduced in-hospital mortality by 41.5% (OR 0.585) compared to <48 hours or ≥16 days groups, with lowest mortality and cost.
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