Key result
Prior CABG linked to ~15% higher 30-day readmissions after de novo PCI for STEMI.
Why the study?
Primary PCI is the standard reperfusion strategy for STEMI, but contemporary real-world outcomes of de novo PCI in older adults with a history of CABG are not well described.
Does a history of prior CABG increase in-hospital adverse events and 30-day all-cause readmissions in older adults (≥65 years) undergoing de novo PCI for STEMI?
Cohort (n=194,958)
Yes
Does a history of prior CABG increase in-hospital adverse events and 30-day all-cause readmissions in older adults (≥65 years) undergoing de novo PCI for STEMI?
Hazard Ratio: 1.145 (95% CI 1.021–1.217)
Absolute Event Rate: 12.79% vs 10.48%
p-value: p=0.015
In older adults (≥65 years) undergoing de novo PCI for STEMI, a history of prior CABG is associated with similar in-hospital mortality and fewer acute in-hospital complications, but a significantly higher risk of 30-day readmission, highlighting the need for enhanced transitional care.
Introduction Primary percutaneous coronary intervention (PCI) is the standard reperfusion strategy for ST-elevation myocardial infarction (STEMI). However, contemporary real-world outcomes of de novo PCI in older adults with a history of coronary artery bypass grafting (CABG) are not well described. We compared in-hospital outcomes and 30-day readmissions after STEMI-related de novo PCI among older patients with and without prior CABG. Material and methods Using the Nationwide Readmissions Database (2016–2022), we identified patients aged ≥ 65 years hospitalized with a primary diagnosis of STEMI who underwent de novo PCI. Patients were stratified by prior CABG status. Multivariable logistic regression assessed in-hospital adverse events (including mortality). Among survivors, Cox proportional hazards models were used to evaluate 30-day all-cause readmissions. Results Among 194,958 patients, 9,929 (5.09%) had prior CABG, and 185,029 (94.91%) did not. After adjustment, prior CABG was associated with lower odds of acute kidney injury (AKI), cardiac arrest, cardiogenic shock, and vasopressor use. There were no significant differences in mechanical circulatory support, AKI requiring hemodialysis, ischemic stroke, hemorrhagic stroke, or in-hospital mortality. Among survivors, 30-day readmissions were more frequent among patients with prior CABG (12.79% vs. 10.48%; HR = 1.145, 95% CI: 1.021–1.217; p = 0.015). Mean time to readmission was similar (10.66 vs. 10.54 days; p = 0.757). Conclusions In older STEMI patients undergoing de novo PCI, prior CABG was associated with similar in-hospital mortality and fewer in-hospital adverse events, but higher 30-day readmission risk. These findings suggest that while prior CABG may not worsen immediate outcomes, it identifies patients who may benefit from enhanced post-discharge follow-up and transitional care.
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Anamika et al. (2026) conducted a cohort in ST-elevation myocardial infarction (STEMI) undergoing de novo percutaneous coronary intervention (PCI) (n=194,958). Prior coronary artery bypass grafting (CABG) vs. No prior CABG was evaluated on 30-day all-cause readmission among survivors (HR 1.145, 95% CI 1.021-1.217, p=0.015). Prior CABG was associated with a higher 30-day all-cause readmission rate (12.79% vs 10.48%; HR 1.145, 95% CI 1.021-1.217, p=0.015) in older STEMI patients undergoing de novo PCI.
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