Utilization, Characteristics, and In-Hospital Outcomes of Coronary Artery Bypass Grafting in Patients with ST-Segment-Elevation Myocardial Infarction: Results from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines

Yi Pi, Matthew T. Roe, Dajuanicia N. Holmes, Karen Chiswell, J. Lee Garvey, Gregg C. Fonarow, James A de Lemos, Kirk N. Garratt, Ying Xian

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background - There are limited data on the utilization and outcomes of coronary artery bypass grafting (CABG) among ST-segment-elevation myocardial infarction (STEMI) patients in contemporary practice. Methods and Results - Using data from National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines between 2007 and 2014, we analyzed trends in CABG utilization and hospital-level variation in CABG rates. Patients undergoing CABG during the index admission were categorized by the most common scenarios: (1) CABG only as the primary reperfusion strategy; (2) CABG after primary percutaneous coronary intervention; and (3) CABG after fibrinolytic therapy. A total of 15 145 patients (6.3% of the STEMI population) underwent CABG during the index hospitalization, with a decrease in utilization from 8.3% in 2007 to 5.4% in 2014 (trend P value <0.001). The hospital-level use of CABG in STEMI varied widely from 0.5% to 36.2% (median, 5.3%; interquartile range [IQR], 3.5%-7.8%; P value <0.001). Of all patients undergoing CABG, 45.8% underwent CABG only, 38.7% had CABG after percutaneous coronary intervention, and 8.2% CABG after fibrinolytic therapy. The median time intervals from cardiac catheterization/percutaneous coronary intervention to CABG were 23.3 hours (IQR, 3.0-70.3 hours) in CABG only, 49.7 hours (IQR, 3.2-70.3 hours) in CABG after percutaneous coronary intervention, and 56.6 hours (IQR, 22.7-96.0 hours) in CABG after fibrinolytic therapy. The Acute Coronary Treatment and Intervention Outcomes Network mortality risk scores differed modestly (median, 33; IQR, 28-40 versus median, 32; IQR, 27-38) between CABG and non-CABG patients. Patients undergoing CABG had similar in-hospital mortality rate (5.4% versus 5.1%) as those not treated with CABG. Conclusions - CABG is performed infrequently in STEMI patients during the index hospitalization, with rates declining in contemporary US practice over time. There was marked hospital-level variation in the use of CABG, and CABG was typically performed within 1 to 3 days after angiography. Observed mortality rates appear low, suggesting that CABG might be safely performed in select STEMI patients in a timely fashion.

Original languageEnglish (US)
JournalCirculation: Cardiovascular Quality and Outcomes
Volume10
Issue number8
DOIs
StatePublished - Aug 1 2017

Fingerprint

Coronary Artery Bypass
Registries
Guidelines
Percutaneous Coronary Intervention
ST Elevation Myocardial Infarction
Thrombolytic Therapy
Mortality
Hospitalization

Keywords

  • coronary artery bypass
  • hospital mortality
  • hospitalization
  • percutaneous coronary intervention
  • thrombolytic therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{72c33b34a00b4797be77ad4b7987b798,
title = "Utilization, Characteristics, and In-Hospital Outcomes of Coronary Artery Bypass Grafting in Patients with ST-Segment-Elevation Myocardial Infarction: Results from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines",
abstract = "Background - There are limited data on the utilization and outcomes of coronary artery bypass grafting (CABG) among ST-segment-elevation myocardial infarction (STEMI) patients in contemporary practice. Methods and Results - Using data from National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines between 2007 and 2014, we analyzed trends in CABG utilization and hospital-level variation in CABG rates. Patients undergoing CABG during the index admission were categorized by the most common scenarios: (1) CABG only as the primary reperfusion strategy; (2) CABG after primary percutaneous coronary intervention; and (3) CABG after fibrinolytic therapy. A total of 15 145 patients (6.3{\%} of the STEMI population) underwent CABG during the index hospitalization, with a decrease in utilization from 8.3{\%} in 2007 to 5.4{\%} in 2014 (trend P value <0.001). The hospital-level use of CABG in STEMI varied widely from 0.5{\%} to 36.2{\%} (median, 5.3{\%}; interquartile range [IQR], 3.5{\%}-7.8{\%}; P value <0.001). Of all patients undergoing CABG, 45.8{\%} underwent CABG only, 38.7{\%} had CABG after percutaneous coronary intervention, and 8.2{\%} CABG after fibrinolytic therapy. The median time intervals from cardiac catheterization/percutaneous coronary intervention to CABG were 23.3 hours (IQR, 3.0-70.3 hours) in CABG only, 49.7 hours (IQR, 3.2-70.3 hours) in CABG after percutaneous coronary intervention, and 56.6 hours (IQR, 22.7-96.0 hours) in CABG after fibrinolytic therapy. The Acute Coronary Treatment and Intervention Outcomes Network mortality risk scores differed modestly (median, 33; IQR, 28-40 versus median, 32; IQR, 27-38) between CABG and non-CABG patients. Patients undergoing CABG had similar in-hospital mortality rate (5.4{\%} versus 5.1{\%}) as those not treated with CABG. Conclusions - CABG is performed infrequently in STEMI patients during the index hospitalization, with rates declining in contemporary US practice over time. There was marked hospital-level variation in the use of CABG, and CABG was typically performed within 1 to 3 days after angiography. Observed mortality rates appear low, suggesting that CABG might be safely performed in select STEMI patients in a timely fashion.",
keywords = "coronary artery bypass, hospital mortality, hospitalization, percutaneous coronary intervention, thrombolytic therapy",
author = "Yi Pi and Roe, {Matthew T.} and Holmes, {Dajuanicia N.} and Karen Chiswell and Garvey, {J. Lee} and Fonarow, {Gregg C.} and {de Lemos}, {James A} and Garratt, {Kirk N.} and Ying Xian",
year = "2017",
month = "8",
day = "1",
doi = "10.1161/CIRCOUTCOMES.116.003490",
language = "English (US)",
volume = "10",
journal = "Circulation: Cardiovascular Quality and Outcomes",
issn = "1941-7713",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - Utilization, Characteristics, and In-Hospital Outcomes of Coronary Artery Bypass Grafting in Patients with ST-Segment-Elevation Myocardial Infarction

T2 - Results from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines

AU - Pi, Yi

AU - Roe, Matthew T.

AU - Holmes, Dajuanicia N.

AU - Chiswell, Karen

AU - Garvey, J. Lee

AU - Fonarow, Gregg C.

AU - de Lemos, James A

AU - Garratt, Kirk N.

AU - Xian, Ying

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background - There are limited data on the utilization and outcomes of coronary artery bypass grafting (CABG) among ST-segment-elevation myocardial infarction (STEMI) patients in contemporary practice. Methods and Results - Using data from National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines between 2007 and 2014, we analyzed trends in CABG utilization and hospital-level variation in CABG rates. Patients undergoing CABG during the index admission were categorized by the most common scenarios: (1) CABG only as the primary reperfusion strategy; (2) CABG after primary percutaneous coronary intervention; and (3) CABG after fibrinolytic therapy. A total of 15 145 patients (6.3% of the STEMI population) underwent CABG during the index hospitalization, with a decrease in utilization from 8.3% in 2007 to 5.4% in 2014 (trend P value <0.001). The hospital-level use of CABG in STEMI varied widely from 0.5% to 36.2% (median, 5.3%; interquartile range [IQR], 3.5%-7.8%; P value <0.001). Of all patients undergoing CABG, 45.8% underwent CABG only, 38.7% had CABG after percutaneous coronary intervention, and 8.2% CABG after fibrinolytic therapy. The median time intervals from cardiac catheterization/percutaneous coronary intervention to CABG were 23.3 hours (IQR, 3.0-70.3 hours) in CABG only, 49.7 hours (IQR, 3.2-70.3 hours) in CABG after percutaneous coronary intervention, and 56.6 hours (IQR, 22.7-96.0 hours) in CABG after fibrinolytic therapy. The Acute Coronary Treatment and Intervention Outcomes Network mortality risk scores differed modestly (median, 33; IQR, 28-40 versus median, 32; IQR, 27-38) between CABG and non-CABG patients. Patients undergoing CABG had similar in-hospital mortality rate (5.4% versus 5.1%) as those not treated with CABG. Conclusions - CABG is performed infrequently in STEMI patients during the index hospitalization, with rates declining in contemporary US practice over time. There was marked hospital-level variation in the use of CABG, and CABG was typically performed within 1 to 3 days after angiography. Observed mortality rates appear low, suggesting that CABG might be safely performed in select STEMI patients in a timely fashion.

AB - Background - There are limited data on the utilization and outcomes of coronary artery bypass grafting (CABG) among ST-segment-elevation myocardial infarction (STEMI) patients in contemporary practice. Methods and Results - Using data from National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines between 2007 and 2014, we analyzed trends in CABG utilization and hospital-level variation in CABG rates. Patients undergoing CABG during the index admission were categorized by the most common scenarios: (1) CABG only as the primary reperfusion strategy; (2) CABG after primary percutaneous coronary intervention; and (3) CABG after fibrinolytic therapy. A total of 15 145 patients (6.3% of the STEMI population) underwent CABG during the index hospitalization, with a decrease in utilization from 8.3% in 2007 to 5.4% in 2014 (trend P value <0.001). The hospital-level use of CABG in STEMI varied widely from 0.5% to 36.2% (median, 5.3%; interquartile range [IQR], 3.5%-7.8%; P value <0.001). Of all patients undergoing CABG, 45.8% underwent CABG only, 38.7% had CABG after percutaneous coronary intervention, and 8.2% CABG after fibrinolytic therapy. The median time intervals from cardiac catheterization/percutaneous coronary intervention to CABG were 23.3 hours (IQR, 3.0-70.3 hours) in CABG only, 49.7 hours (IQR, 3.2-70.3 hours) in CABG after percutaneous coronary intervention, and 56.6 hours (IQR, 22.7-96.0 hours) in CABG after fibrinolytic therapy. The Acute Coronary Treatment and Intervention Outcomes Network mortality risk scores differed modestly (median, 33; IQR, 28-40 versus median, 32; IQR, 27-38) between CABG and non-CABG patients. Patients undergoing CABG had similar in-hospital mortality rate (5.4% versus 5.1%) as those not treated with CABG. Conclusions - CABG is performed infrequently in STEMI patients during the index hospitalization, with rates declining in contemporary US practice over time. There was marked hospital-level variation in the use of CABG, and CABG was typically performed within 1 to 3 days after angiography. Observed mortality rates appear low, suggesting that CABG might be safely performed in select STEMI patients in a timely fashion.

KW - coronary artery bypass

KW - hospital mortality

KW - hospitalization

KW - percutaneous coronary intervention

KW - thrombolytic therapy

UR - http://www.scopus.com/inward/record.url?scp=85028919540&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85028919540&partnerID=8YFLogxK

U2 - 10.1161/CIRCOUTCOMES.116.003490

DO - 10.1161/CIRCOUTCOMES.116.003490

M3 - Article

C2 - 28794118

AN - SCOPUS:85028919540

VL - 10

JO - Circulation: Cardiovascular Quality and Outcomes

JF - Circulation: Cardiovascular Quality and Outcomes

SN - 1941-7713

IS - 8

ER -