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)

Shailja V. Parikh, James A de Lemos, Michael E Jessen, Emmanouil S Brilakis, E. Magnus Ohman, Anita Y. Chen, Tracy Y. Wang, Eric D. Peterson, Matthew T. Roe, Elizabeth M. Holper

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Abstract

Objectives: The aim of this study was to examine timing of in-hospital coronary artery bypass graft surgery (CABG) for nonST-segment elevation myocardial infarction (NSTEMI) patients. Background: Although practice guidelines recommend delaying CABG for a few days after presentation for ST-segment elevation myocardial infarction patients, current guidelines for NSTEMI patients do not address optimal CABG timing. Methods: We evaluated rates and timing of in-hospital CABG among NSTEMI patients treated at U.S. hospitals from 2002 to 2008 with the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines) (January 2002 to December 2006) and ACTION RegistryGWTG (Acute Coronary Treatment and Intervention Outcomes Network RegistryGet With The Guidelines) (January 2007 to June 2008) programs. Analyses designed to study the clinical characteristics and outcomes of early (≤48 h, n = 825) versus late (>48 h, n = 1,822) CABG focused upon more recent NSTEMI patients from the ACTION RegistryGWTG. Results: Both the rate (11% to 13%) and timing (30% early and 70% late) of in-hospital CABG remained consistent from 2002 to 2008. In the ACTION RegistryGWTG program, NSTEMI patients undergoing late CABG tended to have a higher risk profile than those undergoing early CABG. In-hospital mortality (3.6% vs. 3.8%, adjusted odds ratio: 1.12, 95% confidence interval: 0.71 to 1.78) and the composite outcome of death, myocardial infarction, congestive heart failure, or cardiogenic shock (12.6% vs. 12.4%, adjusted odds ratio: 0.94, 95% confidence interval: 0.69 to 1.28) were similar between patients undergoing early versus late CABG. Conclusions: Most NSTEMI patients undergo late CABG after hospital arrival. Although these patients have higher-risk clinical characteristics, they have the same risk of adverse clinical outcomes compared with patients who undergo early CABG. Thus, delaying CABG routinely after NSTEMI might increase resource use without improving outcomes. Additionally, the timing of CABG for NSTEMI patients might be appropriately determined by clinicians to minimize the risk of adverse clinical events.

Original languageEnglish (US)
Pages (from-to)419-427
Number of pages9
JournalJACC: Cardiovascular Interventions
Volume3
Issue number4
DOIs
StatePublished - Mar 2010

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Coronary Artery Bypass
Registries
Guidelines
Transplants
Myocardial Infarction
Non-ST Elevated Myocardial Infarction
Odds Ratio
Confidence Intervals
Cardiogenic Shock
Unstable Angina
Hospital Mortality
Practice Guidelines
Heart Failure
Outcome Assessment (Health Care)

Keywords

  • acute coronary syndrome
  • coronary artery bypass graft surgery
  • nonST-segment elevation myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

@article{d39d561121d4492fa84c3acb7fd912ed,
title = "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)",
abstract = "Objectives: The aim of this study was to examine timing of in-hospital coronary artery bypass graft surgery (CABG) for nonST-segment elevation myocardial infarction (NSTEMI) patients. Background: Although practice guidelines recommend delaying CABG for a few days after presentation for ST-segment elevation myocardial infarction patients, current guidelines for NSTEMI patients do not address optimal CABG timing. Methods: We evaluated rates and timing of in-hospital CABG among NSTEMI patients treated at U.S. hospitals from 2002 to 2008 with the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines) (January 2002 to December 2006) and ACTION RegistryGWTG (Acute Coronary Treatment and Intervention Outcomes Network RegistryGet With The Guidelines) (January 2007 to June 2008) programs. Analyses designed to study the clinical characteristics and outcomes of early (≤48 h, n = 825) versus late (>48 h, n = 1,822) CABG focused upon more recent NSTEMI patients from the ACTION RegistryGWTG. Results: Both the rate (11{\%} to 13{\%}) and timing (30{\%} early and 70{\%} late) of in-hospital CABG remained consistent from 2002 to 2008. In the ACTION RegistryGWTG program, NSTEMI patients undergoing late CABG tended to have a higher risk profile than those undergoing early CABG. In-hospital mortality (3.6{\%} vs. 3.8{\%}, adjusted odds ratio: 1.12, 95{\%} confidence interval: 0.71 to 1.78) and the composite outcome of death, myocardial infarction, congestive heart failure, or cardiogenic shock (12.6{\%} vs. 12.4{\%}, adjusted odds ratio: 0.94, 95{\%} confidence interval: 0.69 to 1.28) were similar between patients undergoing early versus late CABG. Conclusions: Most NSTEMI patients undergo late CABG after hospital arrival. Although these patients have higher-risk clinical characteristics, they have the same risk of adverse clinical outcomes compared with patients who undergo early CABG. Thus, delaying CABG routinely after NSTEMI might increase resource use without improving outcomes. Additionally, the timing of CABG for NSTEMI patients might be appropriately determined by clinicians to minimize the risk of adverse clinical events.",
keywords = "acute coronary syndrome, coronary artery bypass graft surgery, nonST-segment elevation myocardial infarction",
author = "Parikh, {Shailja V.} and {de Lemos}, {James A} and Jessen, {Michael E} and Brilakis, {Emmanouil S} and Ohman, {E. Magnus} and Chen, {Anita Y.} and Wang, {Tracy Y.} and Peterson, {Eric D.} and Roe, {Matthew T.} and Holper, {Elizabeth M.}",
year = "2010",
month = "3",
doi = "10.1016/j.jcin.2010.01.012",
language = "English (US)",
volume = "3",
pages = "419--427",
journal = "JACC: Cardiovascular Interventions",
issn = "1936-8798",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Timing of in-hospital coronary artery bypass graft surgery for non-ST-segment elevation myocardial infarction patients

T2 - Results from the national cardiovascular data registry action registry-GWTG (acute coronary treatment and intervention outcomes network registry-get with the guidelines)

AU - Parikh, Shailja V.

AU - de Lemos, James A

AU - Jessen, Michael E

AU - Brilakis, Emmanouil S

AU - Ohman, E. Magnus

AU - Chen, Anita Y.

AU - Wang, Tracy Y.

AU - Peterson, Eric D.

AU - Roe, Matthew T.

AU - Holper, Elizabeth M.

PY - 2010/3

Y1 - 2010/3

N2 - Objectives: The aim of this study was to examine timing of in-hospital coronary artery bypass graft surgery (CABG) for nonST-segment elevation myocardial infarction (NSTEMI) patients. Background: Although practice guidelines recommend delaying CABG for a few days after presentation for ST-segment elevation myocardial infarction patients, current guidelines for NSTEMI patients do not address optimal CABG timing. Methods: We evaluated rates and timing of in-hospital CABG among NSTEMI patients treated at U.S. hospitals from 2002 to 2008 with the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines) (January 2002 to December 2006) and ACTION RegistryGWTG (Acute Coronary Treatment and Intervention Outcomes Network RegistryGet With The Guidelines) (January 2007 to June 2008) programs. Analyses designed to study the clinical characteristics and outcomes of early (≤48 h, n = 825) versus late (>48 h, n = 1,822) CABG focused upon more recent NSTEMI patients from the ACTION RegistryGWTG. Results: Both the rate (11% to 13%) and timing (30% early and 70% late) of in-hospital CABG remained consistent from 2002 to 2008. In the ACTION RegistryGWTG program, NSTEMI patients undergoing late CABG tended to have a higher risk profile than those undergoing early CABG. In-hospital mortality (3.6% vs. 3.8%, adjusted odds ratio: 1.12, 95% confidence interval: 0.71 to 1.78) and the composite outcome of death, myocardial infarction, congestive heart failure, or cardiogenic shock (12.6% vs. 12.4%, adjusted odds ratio: 0.94, 95% confidence interval: 0.69 to 1.28) were similar between patients undergoing early versus late CABG. Conclusions: Most NSTEMI patients undergo late CABG after hospital arrival. Although these patients have higher-risk clinical characteristics, they have the same risk of adverse clinical outcomes compared with patients who undergo early CABG. Thus, delaying CABG routinely after NSTEMI might increase resource use without improving outcomes. Additionally, the timing of CABG for NSTEMI patients might be appropriately determined by clinicians to minimize the risk of adverse clinical events.

AB - Objectives: The aim of this study was to examine timing of in-hospital coronary artery bypass graft surgery (CABG) for nonST-segment elevation myocardial infarction (NSTEMI) patients. Background: Although practice guidelines recommend delaying CABG for a few days after presentation for ST-segment elevation myocardial infarction patients, current guidelines for NSTEMI patients do not address optimal CABG timing. Methods: We evaluated rates and timing of in-hospital CABG among NSTEMI patients treated at U.S. hospitals from 2002 to 2008 with the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines) (January 2002 to December 2006) and ACTION RegistryGWTG (Acute Coronary Treatment and Intervention Outcomes Network RegistryGet With The Guidelines) (January 2007 to June 2008) programs. Analyses designed to study the clinical characteristics and outcomes of early (≤48 h, n = 825) versus late (>48 h, n = 1,822) CABG focused upon more recent NSTEMI patients from the ACTION RegistryGWTG. Results: Both the rate (11% to 13%) and timing (30% early and 70% late) of in-hospital CABG remained consistent from 2002 to 2008. In the ACTION RegistryGWTG program, NSTEMI patients undergoing late CABG tended to have a higher risk profile than those undergoing early CABG. In-hospital mortality (3.6% vs. 3.8%, adjusted odds ratio: 1.12, 95% confidence interval: 0.71 to 1.78) and the composite outcome of death, myocardial infarction, congestive heart failure, or cardiogenic shock (12.6% vs. 12.4%, adjusted odds ratio: 0.94, 95% confidence interval: 0.69 to 1.28) were similar between patients undergoing early versus late CABG. Conclusions: Most NSTEMI patients undergo late CABG after hospital arrival. Although these patients have higher-risk clinical characteristics, they have the same risk of adverse clinical outcomes compared with patients who undergo early CABG. Thus, delaying CABG routinely after NSTEMI might increase resource use without improving outcomes. Additionally, the timing of CABG for NSTEMI patients might be appropriately determined by clinicians to minimize the risk of adverse clinical events.

KW - acute coronary syndrome

KW - coronary artery bypass graft surgery

KW - nonST-segment elevation myocardial infarction

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