Ideal Timing of Coronary Artery Bypass Grafting after Non-ST Elevation Myocardial Infarction.

IF 3.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery Pub Date : 2025-02-11 DOI:10.1016/j.athoracsur.2025.01.024

Anthony V Norman, Matthew P Weber, Mohamad El Moheb, Alexander M Wisniewski, Raymond J Strobel, Alan Speir, Michael Mazzeffi, Aarathi Manchikalapud, Mark Joseph, Daniel Tang, Ramesh Singh, Mohammed Quader, Jared P Beller, Kenan Yount, Nicholas R Teman

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引用次数: 0

Abstract

Background: Non-ST elevation myocardial infarction (NSTEMI) patients benefit from revascularization, but guidelines are vague regarding optimal timing. We aimed to identify the ideal timing of coronary artery bypass grafting (CABG) after NSTEMI.

Methods: We examined NSTEMI patients who underwent isolated CABG within 30 days of cardiac catheterization between July 2011-July 2023 using a multicenter regional collaborative. Patients were stratified into three groups: <2 days, 3-7 days, and 8-30 days. Multivariable logistic regression analysis was performed to identify risk factors associated with mortality.

Results: We identified 10,271 CABG patients, of which 3,464 (34%) underwent CABG within <2 days, 5,751 (56%) 3-7 days, and 1056 (10%) 8-30 days. The 3-7 day group had the lowest median Society of Thoracic Surgeons predicted risk of mortality (1.36% vs. 1.35% vs. 2.09%, p<0.001). The <2 day group more frequently presented with left main disease (19% vs. 16% vs. 16%, p<0.001) and cardiogenic shock (5.1% vs. 1.8% vs. 2%, p<0.001). Mean cardiopulmonary bypass time was similar between groups (97 mins vs 97 vs 97, p=0.63). The 3-7 day group had the lowest operative mortality (3.2% vs. 1.8% vs. 4%, p<0.001) and major morbidity (14% vs 11% vs. 16%, p<0.001). After risk-adjustment, the 3-7 day window was associated with decreased mortality compared to <2 days (OR 0.56, 95%CI 0.4-0.78, p<0.001) and 8-30 days (OR 0.51, 95%CI 0.32-0.81, p<0.001).

Conclusions: CABG between 3-7 days after cardiac catheterization for NSTEMI was associated with the lowest risk of mortality. When possible, CABG within this window may afford better outcomes.

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.