Does Timing of Coronary Artery Bypass Surgery Affect Early and Long-Term Outcomes in Patients With Non–ST-Segment–Elevation Myocardial Infarction?. Issue 8 (25th August 2015)

• Record Type: Journal Article
• Authors: Davierwala, Piroze M.; Verevkin, Alexander; Leontyev, Sergey; Misfeld, Martin; Borger, Michael A.; Mohr, Friedrich W.
• Is Part Of: Circulation. Volume 132:Issue 8(2015)
• Publication Date: 2015-08-25
• Subjects: Blood -- Circulation -- Periodicals; Cardiovascular system -- Periodicals; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Blood Circulation; Cardiovascular System; Vascular Diseases; 616.1
• DOI: 10.1161/CIRCULATIONAHA.115.015279
• Languages: English
• ISSNs: 0009-7322

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background—</title> <p>Current guidelines do not provide recommendations for optimal timing of coronary artery bypass surgery (CABG) in patients with non–ST-segment–elevation myocardial infarction. Our study aimed to determine the impact of CABG timing on early and late outcomes in patients with non–ST-segment–elevation myocardial infarction.</p> </sec> <sec> <title>Methods and Results—</title> <p>A total of 758 patients underwent CABG within 21 days after non–ST-segment–elevation myocardial infarction between January 2008 and December 2012 at our institution. The patients were divided into 3 groups according to the time interval between symptom onset and CABG: group A, <24 hours (133 patients); group B, 24 to 72 hours (192 patients); and group C, >72 hours to 21 days (433 patients). Predictors of in-hospital and long-term mortality were identified by logistic and Cox regression analyses, respectively. Overall in-hospital mortality was 5.1% (39 patients): 6.0%, 4.7%, and 5.1% in groups A, B, and C (<italic>P</italic>=0.9), respectively. A total of 118 patients died during follow-up. The 5-year survival was 73.1±2%, with a nonsignificant trend toward better survival in groups A (78.2±4%) and C (75.4±3%) compared with group B (63.6±5%; log-rank <italic>P</italic>=0.06). Renal insufficiency and LMD were independent predictors of in-hospital (odds ratio, 3.1; <italic>P</italic>=0.001; and odds ratio, 3.1; <italic>P</italic>=0.002) and long-term mortality (hazard ratio, 1.7; <italic>P</italic>=0.004; and hazard ratio, 1.5; <italic>P</italic>=0.02), whereas administration of P2Y<sub>12</sub> inhibitors was protective (odds ratio, 0.3; <italic>P</italic>=0.01).</p> </sec> <sec> <title>Conclusions—</title> <p>Emergent CABG within 24 hours of non–ST-segment–elevation myocardial infarction is associated with in-hospital mortality and long-term outcomes similar to those of CABG performed after 3 days, despite a higher risk profile. CABG performed between 24 to 72 hours showed a nonsignificant trend toward poorer long-term outcomes. Dual antiplatelet therapy until surgery is beneficial, whereas renal insufficiency and left main disease increase the risk of early and late death.</p> </sec> </abstract>