Key result
Early CABG in NSTEMI shows comparable 6-month mortality and MACE to delayed CABG.
Why the study?
There is no consensus on the optimal timing for CABG in NSTEMI, and whether early surgery can be performed safely remains unclear given concerns of increased operative risk.
Does early CABG (<72 h) improve 6-month mortality and MACE compared to delayed CABG (>72 h) in patients with NSTEMI?
Observational (n=217)
No
Does early CABG (<72 h) improve 6-month mortality and MACE compared to delayed CABG (>72 h) in patients with NSTEMI?
p-value: p=0.982
Early CABG (<72 hours) in NSTEMI patients appears to be as safe as delayed CABG, despite early-revascularized patients having a higher level of illness.
Early CABG showed comparable safety to delayed in selected NSTEMI; leaves open optimal timing in broader or higher-risk populations.
BACKGROUND: In non-ST-elevation myocardial infarction (NSTEMI) there is no consensus regarding optimal time point for coronary artery bypass grafting (CABG). Recent findings suggest that long-term outcomes are improved in early-revascularized NSTEMI patients. However, it has been stated that early surgery is associated to increased operative risk. In this study, we wanted to elucidate if early CABG in non-ST-elevation acute coronary syndrome can be performed safely. METHODS: We performed a monocentric-prospective observational study within a 2-year interval. A total of 217 consecutive patients (41 female, age 68.9±10.2, ES II 6.62±8.56) developed NSTEMI and underwent CABG. Patients were divided into two groups according to the time point of coronary artery bypass after symptom onset (group A: <72 h; group B: >72 h). Endpoints included 6-month mortality and incidence of MACE (death, stroke or re-infarction). RESULTS: . 9.7%, P=0.982). Regression analysis revealed as independent risk factors for mortality in the entire cohort ES II OR 1.045 (95% CI: 1.004-1.088). ES II remained an independent prognostic factor in group A OR 1.043 (95% CI: 1.003-1.086) and group B OR 1.032 (95% CI: 1.001-1.063). CONCLUSIONS: Early revascularized patients showed a higher level of illness. However, results of early CABG were comparable to those following delayed revascularization. Moreover, EuroSCORE II was determined as independent risk factors for mortality.
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Rojas et al. (2019) conducted an observational in non-ST-elevation myocardial infarction (NSTEMI) (n=217). Early CABG (<72 h after symptom onset) vs. Delayed CABG (>72 h after symptom onset) was evaluated on 6-month mortality and incidence of MACE (death, stroke or re-infarction) (p=0.982). Early CABG (<72 hours after symptom onset) in NSTEMI patients resulted in comparable outcomes to delayed revascularization (>72 hours) (P=0.982).
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