Elsevier

The American Journal of Cardiology

Volume 134, 1 November 2020, Pages 32-40
The American Journal of Cardiology

Trends in Utilization and Safety of In-Hospital Coronary Artery Bypass Grafting During a Non-ST-Segment Elevation Myocardial Infarction

https://doi.org/10.1016/j.amjcard.2020.08.019Get rights and content

Up to 10% of non-ST-segment elevation myocardial infarction (NSTEMI) patients require coronary artery bypass graft (CABG) surgery during their hospitalization. Contemporary, real-world, data regarding CABG utilization and safety in NSTEMI patients are lacking. Our objectives were to investigate the contemporary trends in utilization and outcomes of CABG in patients admitted for NSTEMI. Using the 2003 to 2015 National Inpatient Sample data, we identified hospitalizations for NSTEMI, during which a CABG was performed. Patients’ sociodemographic and clinical characteristics, incidence of surgical complications, length of stay, and mortality were analyzed. Multivariate analyses were performed to identify predictors of in-hospital complications and mortality. An estimated total of 440,371 CABG surgeries, during a hospitalization for NSTEMI, were analyzed. The utilization of CABG was steady over the years. The data show increasing prevalence of individual co-morbidities as well as cases with Deyo Co-morbidity Index ≥2 (p <0.001). High, 26.4%, complication rate was driven mainly by cardiac and pulmonary complications. The mortality rate declined from 3.6% in 2003 to an average of 2.4% during 2010 to 2015. Older age, female gender, heart failure, and delayed CABG timing were independent predictors of adverse outcomes. In conclusion, utilization of in-hospital CABG as the primary revascularization strategy in patients with NSTEMI remained steady over the years. These data reveal the raising prevalence of co-morbidities during the study. High complication rate was recorded; however, the mortality declined over the years to about 2.4%. Delaying CABG was associated with small but statistically significant worsening in outcomes.

Section snippets

Methods

The data were drawn from the NIS, the Healthcare Cost and Utilization Project, and Agency for Healthcare Research and Quality (AHRQ).6 The NIS datasets include only de-identified data; therefore, this study was deemed exempt from institutional review by the Human Research Committee.

The NIS is the largest collection of all-payer data on in-patient hospitalizations in the United States. The dataset represents an approximate 20% stratified sample of all inpatient discharges from US hospitals.7

Results

Out of 98,754,774 unweighted hospitalizations in the NIS database during the 1/2003 to 9/2015 period, a total of 91,673 hospitalizations were included in the analysis based on the inclusion criteria described above. After implementing the weighting method, these represented an estimated total of 440,371 hospitalizations for NSTEMI, in patients who underwent in-hospital CABG during the index hospitalization. The majority of patients (70.7%) were male and the mean age of the cohort was 65 years.

Discussion

Utilizing data from the NIS, the largest all-payer inpatient database in the United States, we identified a weighted total of 440,371 patients, who underwent CABG during their hospitalization for NSTEMI. The data show a relatively steady utilization of CABG in NSTEMI patients during the study period (2003 to 2015). That trend is consistent with previous studies that demonstrated modest increases in utilization of in-hospital CABG in NSTEMI patients during the early 1990s, remaining relatively

Author Contribution

Gabby Elbaz-Greener—study design, data interpretation, drafting the manuscript; Guy Rozen—conceptualization, drafting the manuscript; Fabio Kusniec—data analysis, data interpretation; Ibrahim Marai—data analysis, data interpretation; Diab Ghanim—critical revision of the manuscript; Shemy Carasso—critical revision of the manuscript, supervision, Yulia Gavrilov—methodology, data interpretation; Maneesh Sud—data interpretation, drafting the manuscript; Bradley Strauss—critical revision of the

Disclosures

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgment

The corresponding author affirms that he has listed everyone who contributed significantly to the work. The corresponding author had access to all the study data, took responsibility for the accuracy of the analysis, and had authority over manuscript preparation and the decision to submit the manuscript for publication. The corresponding author confirms that all authors read and approve the manuscript.

References (29)

  • D Paparella et al.

    Preoperative cardiac troponin I to assess midterm risks of coronary bypass grafting operations in patients with recent myocardial infarction

    Ann Thorac Surg

    (2010)
  • DG Katritsis et al.

    Optimal timing of coronary angiography and potential intervention in non-ST-elevation acute coronary syndromes

    Eur Heart J

    (2011)
  • M Roffi et al.

    2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)

    Eur Heart J

    (2016)
  • FJ Neumann et al.

    2018 ESC/EACTS Guidelines on myocardial revascularization

    Eur Heart J

    (2019)
  • Cited by (6)

    Funding: None.

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    These authors contributed equally to this study and manuscript preparation.

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