Meta-Analysis of Nonrandomized Studies to Assess the Optimal Timing of Coronary Artery Bypass Grafting After Acute Myocardial Infarction
Section snippets
Methods
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed and is detailed in Supplementary Figure 1. Studies published between 2000 and 2020 were identified using MEDLINE, the search syntax used for literature review is listed in Supplementary Table 1. This systematic review was not registered on PROSPERO.
Studies included in the systematic review were nonrandomized retrospective studies that compared mortality in patient groups who underwent CABG after acute
Results
In total 22 retrospective studies, evaluating 137,373 patients, were identified evaluating either 30-day or in-hospital mortality in patients who underwent CABG after acute MI. A total of 9 studies were multi-center registries or population-level databases, whereas 13 studies were from a single institution. A total of 12 studies evaluated CABG after MI (nonspecified), whereas 4 studied CABG after STEMI. CABG after NSTEMI was studied in 5 reports, and CABG after transmural MI was evaluated in 1
Discussion
The present study provides new information by summarizing the proportion of patients who die if they do undergo CABG within a certain period after MI. This is beneficial for prognostic purposes and to inform shared decision-making; however, we would caution that it is insufficient to compare mortality across subgroups in such a way that one might say that waiting longer improves survival as these associations are not likely causal. Although delayed CABG is associated with improved CABG-related
Disclosures
The authors have no conflicts of interest to declare.
References (29)
- et al.
American College of Cardiology Foundation, American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, Society of Thoracic Surgeons. 011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons
J Am Coll Cardiol
(2011) - et al.
Appropriate timing of surgical intervention after transmural acute myocardial infarction
J Thorac Cardiovasc Surg
(2003) - et al.
Coronary artery bypass surgery in patients with acute coronary syndromes is difficult to predict
Am Heart J
(2008) - et al.
Predictors and outcomes of coronary artery bypass grafting in ST elevation myocardial infarction
Ann Thorac Surg
(2007) - et al.
Timing of in-hospital coronary artery bypass graft surgery for non–ST-segment elevation myocardial infarction patients results from the National Cardiovascular Data Registry ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines)
JACC Cardiovasc Interv
(2010) - et al.
Northern New England Cardiovascular Disease Study Group. Optimal timing from myocardial infarction to coronary artery bypass grafting on hospital mortality
Ann Thorac Surg
(2017) - et al.
Surgical revascularisation in the early phase of ST-segment elevation myocardial infarction: haemodynamic status is more important than the timing of the operation
Hear Lung Circ
(2017) - et al.
Impact of delay in surgery on outcome in patients undergoing cardiac revascularisation surgery
Hear Lung Circ
(2021) - et al.
ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions
BMJ
(2016) - et al.
Transformations related to the angular and the square root
Ann Math Statist
(1950)
Measuring inconsistency in meta-analyses
BMJ
Optimal timing of revascularization: transmural versus nontransmural acute myocardial infarction
Ann Thorac Surg
Influence of time elapsed between myocardial infarction and coronary artery bypass grafting surgery on operative mortality
Eur J Cardiothorac Surg
Surgical revascularization for acute coronary syndrome: comparative surgical and long-term results
Jpn J Thorac Cardiovasc Surg
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2023, Journal of CardiologyCitation Excerpt :In addition, retrospective studies have shown that mortality is lower in patients receiving CABG at later compared with earlier post-MI time points, although the cause-effect relationship is largely unknown [29]. Recent data from large-scale registries demonstrated the conflicting results [30–32], and a recent meta-analysis failed to compare the timing of CABG after acute MI because of serious heterogeneity and risk of bias in patient selection, confounding factors, and intervention time intervals [29]. Future studies, ideally RCTs, are warranted to determine the optimal timing of CABG.
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