Key result
After adjusting for baseline high-risk characteristics, coronary artery bypass grafting during hospitalization for acute myocardial infarction was associated with lower in-hospital mortality in both STEMI (adjusted OR 0.43) and NSTEMI (adjusted OR 0.34) patients.
Why the study?
Little is known about the outcomes of patients with STEMI or NSTEMI who undergo CABG in the current PCI era.
Does coronary artery bypass grafting during hospitalization reduce in-hospital mortality in patients with STEMI or NSTEMI?
Observational (n=25,120)
Yes
Does coronary artery bypass grafting during hospitalization reduce in-hospital mortality in patients with STEMI or NSTEMI?
Odds Ratio: 0.43 (95% CI 0.26–0.72)
Absolute Event Rate: 15.9% vs 7.3%
p-value: p=0.001
Despite being performed in patients with higher-risk baseline characteristics, CABG during hospitalization for AMI is associated with significantly lower adjusted in-hospital mortality compared to non-CABG management.
CABG was associated with lower in-hospital mortality among high-risk AMI patients; leaves open need for randomized trials in the PCI era.
PURPOSE: Little is known about the outcomes of patients with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI) who undergo coronary artery bypass grafting (CABG) in the current percutaneous coronary intervention (PCI) era. METHODS: We analyzed 25120 acute myocardial infarction (AMI) patients hospitalized between January 2011 and December 2016. In-hospital outcomes were compared between patients who underwent CABG during hospitalization and those who did not undergo CABG in the STEMI group (n = 19428) and NSTEMI group (n = 5692). RESULTS: Overall, CABG was performed in 2.3% of patients, while 90.0% of registered patients underwent primary PCI. In both the STEMI and NSTEMI groups, patients who underwent CABG were more likely to have heart failure, cardiogenic shock, diabetes, left main trunk lesion, and multivessel disease than those who did not undergo CABG. In multivariable analysis, CABG was associated with lower all-cause mortality in both the STEMI group (adjusted odds ratio [OR] = 0.43, 95% confidence interval [CI] 0.26-0.72) and NSTEMI group (adjusted OR = 0.34, 95% CI 0.14-0.84). CONCLUSION: AMI patients undergoing CABG were more likely to have high-risk characteristics than those who did not undergo CABG. However, after adjusting for baseline differences, CABG was associated with lower in-hospital mortality in both the STEMI and NSTEMI groups.
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Tomura et al. (2023) conducted an observational in Acute myocardial infarction (STEMI and NSTEMI) (n=25,120). Coronary artery bypass grafting (CABG) vs. No CABG during hospitalization was evaluated on In-hospital mortality (STEMI group) (adjusted OR 0.43, 95% CI 0.26-0.72, p=0.001). After adjusting for baseline high-risk characteristics, coronary artery bypass grafting during hospitalization for acute myocardial infarction was associated with lower in-hospital mortality in both STEMI (adjusted OR 0.43) and NSTEMI (adjusted OR 0.34) patients.
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