The Association of COVID-19 and Mortality in Hospitalizations With Coronary Artery Bypass Graft

Abstract

Background

COVID-19 is associated with a higher burden of cardiovascular morbidity and mortality. The association of COVID-19 and mortality in hospitalizations with coronary artery bypass graft (CABG) has not been determined.

Methods

We conducted a population-based cohort study of the association of COVID-19 and mortality in hospitalizations with CABG using the Texas Inpatient Public Use Data File over the period Q2 2020 through Q4 2023. The primary exposure was a diagnosis of COVID-19, and the primary outcome was in-hospital mortality. Short-term mortality and total length of stay were used as secondary outcomes. The primary analysis approach was overlapping propensity score weighting with treatment weighting and inverse probability of treatment weighting applied as alternative analyses. Results are reported as adjusted risk ratio (aRR) and 95% CI. The adjusted risk difference and 95% CI are provided as an alternative effect size measure.

Results

A total of 47,501 hospitalizations with a procedure code for CABG were identified, of which 509 (1.1%) had COVID-19. CABG hospitalizations with vs without COVID-19 had higher comorbidity index (2.01 ± 1.65 vs 1.65 ± 1.61), more frequent need for invasive mechanical ventilation (12.8% vs 8.5%), had higher rates of myocardial infarction (65.0% vs 45.6%), higher rates of congestive heart failure (53.4% vs 40.1%), and higher rates of acute kidney injury (35.6% vs 24.3%); P < .0001 for each comparison. CABG hospitalizations with COVID-19 had higher unadjusted in-hospital mortality (6.3% vs 2.2%) and unadjusted length of stay (16.2 ± 11.6 days vs 9.6 ± 6.8 days), compared with those without COVID-19. In adjusted analysis, COVID-19 was associated with a 53.9% increase in the risk of in-hospital mortality (aRR, 1.5394; 95% CI, 1.0836 to 2.1870) and a 40.3% increase in length of stay aRR 1.4028 (95% CI, 1.3138 to 1.4978).

Conclusions

COVID-19 was strongly associated with increased mortality in hospitalizations with CABG during the pandemic. The association weakened year over year and by 2023 was no longer present. COVID-19 has remained strongly associated with increased length of stay in hospitalizations with CABG including after the conclusion of the pandemic.