Key result
Emergent CABG for acute MI dropped from 10.5% to 8.7% between 2000 and 2017.
Why the study?
There are limited contemporary data on the use of emergent coronary artery bypass grafting in acute myocardial infarction.
How have the utilization and outcomes of emergent CABG for acute myocardial infarction changed over time in the United States?
Cohort (n=11,622,528)
Yes
How have the utilization and outcomes of emergent CABG for acute myocardial infarction changed over time in the United States?
Despite an increase in patient acuity and multiorgan failure, the utilization of emergent CABG for acute myocardial infarction has decreased while in-hospital mortality has improved over time.
Emergent CABG use for AMI declined over 18 years; leaves open whether this reflects PCI advances or affects high-risk subgroups.
Background There are limited contemporary data on the use of emergent coronary artery bypass grafting (CABG) in acute myocardial infarction. Methods and Results Adult (aged >18 years) acute myocardial infarction admissions were identified using the National (Nationwide) Inpatient Sample (2000–2017) and classified by tertiles of admission year. Outcomes of interest included temporal trends of CABG use; age‐, sex‐, and race‐stratified trends in CABG use; in‐hospital mortality; hospitalization costs; and hospital length of stay. Of the 11 622 528 acute myocardial infarction admissions, emergent CABG was performed in 1 071 156 (9.2%). CABG utilization decreased overall (10.5% [2000] to 8.7% [2017]; adjusted odds ratio [OR], 0.98 [95% CI, 0.98–0.98]; P <0.001), in ST‐segment–elevation myocardial infarction (10.2% [2000] to 5.2% [2017]; adjusted OR, 0.95 [95% CI, 0.95–0.95]; P <0.001) and non–ST‐segment–elevation myocardial infarction (10.8% [2000] to 10.0% [2017]; adjusted OR, 0.99 [95% CI, 0.99–0.99]; P <0.001), with consistent age, sex, and race trends. In 2012 to 2017, compared with 2000 to 2005, admissions receiving emergent CABG were more likely to have non–ST‐segment–elevation myocardial infarction (80.5% versus 56.1%), higher rates of noncardiac multiorgan failure (26.1% versus 8.4%), cardiogenic shock (11.5% versus 6.4%), and use of mechanical circulatory support (19.8% versus 18.7%). In‐hospital mortality in CABG admissions decreased from 5.3% (2000) to 3.6% (2017) (adjusted OR, 0.89; 95% CI, 0.88–0.89 [ P <0.001]) in the overall cohort, with similar temporal trends in patients with ST‐segment–elevation myocardial infarction and non–ST‐segment–elevation myocardial infarction. An increase in lengths of hospital stay and hospitalization costs was seen over time. Conclusions Utilization of CABG has decreased substantially in acute myocardial infarction admissions, especially in patients with ST‐segment–elevation myocardial infarction. Despite an increase in acuity and multiorgan failure, in‐hospital mortality consistently decreased in this population.
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Patlolla et al. (2021) conducted a cohort in Acute Myocardial Infarction (n=11,622,528). Admission year (2017 vs 2000) vs. Admission year 2000 was evaluated on Temporal trends in CABG utilization (adjusted OR 0.98, 95% CI 0.98-0.98, p=<0.001). Between 2000 and 2017, the overall utilization of emergent CABG for acute myocardial infarction admissions significantly decreased from 10.5% to 8.7% (adjusted OR 0.98).
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