Temporal trends, clinical characteristics, and outcomes of emergent coronary artery bypass grafting for acute myocardial infarction in the united states

Abstract

BACKGROUND: There are limited contemporary data on the use of emergent coronary artery bypass grafting (CABG) in acute myocardial infarction. METHODS AND RESULTS: Adult (aged >18 years) acute myocardial infarction admissions were identified using the National (Nationwide) Inpatient Sample (2000–2017) and classified by tertiles of admission year. Outcomes of interest included temporal trends of CABG use; age-, sex-, and race-stratified trends in CABG use; in-hospital mortality; hospitalization costs; and hospital length of stay. Of the 11 622 528 acute myocardial infarction admissions, emergent CABG was performed in 1 071 156 (9.2%). CABG utilization decreased overall (10.5% [2000] to 8.7% [2017]; adjusted odds ratio [OR], 0.98 [95% CI, 0.98–0.98]; P<0.001), in ST-segment–elevation myocardial infarction (10.2% [2000] to 5.2% [2017]; adjusted OR, 0.95 [95% CI, 0.95–0.95]; P<0.001) and non–ST-segment–elevation myocardial infarction (10.8% [2000] to 10.0% [2017]; adjusted OR, 0.99 [95% CI, 0.99–0.99]; P<0.001), with consistent age, sex, and race trends. In 2012 to 2017, compared with 2000 to 2005, admissions receiving emergent CABG were more likely to have non–ST-segment–elevation myocardial infarction (80.5% versus 56.1%), higher rates of noncardiac multiorgan failure (26.1% versus 8.4%), cardiogenic shock (11.5% versus 6.4%), and use of mechanical circulatory support (19.8% versus 18.7%). In-hospital mortality in CABG admissions decreased from 5.3% (2000) to 3.6% (2017) (adjusted OR, 0.89; 95% CI, 0.88–0.89 [P<0.001]) in the overall cohort, with similar temporal trends in patients with ST-segment–elevation myocardial infarction and non–ST-segment–elevation myocardial infarction. An increase in lengths of hospital stay and hospitalization costs was seen over time. CONCLUSIONS: Utilization of CABG has decreased substantially in acute myocardial infarction admissions, especially in patients with ST-segment–elevation myocardial infarction. Despite an increase in acuity and multiorgan failure, in-hospital mortality consistently decreased in this population.