Abstract
Previous studies suggested that coronary artery bypass grafting (CABG) among ST-elevation myocardial infarction (STEMI) patients with systolic heart failure (HF) resulted in low mortality rates. However, there is paucity of data regarding the impact of systolic HF among STEMI patients undergoing CABG (STEMI-CABG) in terms of in-hospital outcomes and use of mechanical circulatory support (MCS). We queried the National Inpatient Sample (NIS) to identify patients with STEMI who underwent CABG using appropriate ICD-10 codes between 2018-2020. We aim to investigate the impact of systolic HF among STEMI-CABG patients based on in-hospital mortality, length of stay (LOS), risk for cardiogenic shock (CS) and MCS utilization. A multivariable logistic regression analysis was used to calculate adjusted odds ratios (ORs) for the outcomes of interest. A total of 486,075 patients hospitalized for STEMI were identified, of which 4.94% (24,015/486,075) underwent CABG. Among STEMI-CABG patients, 23.15% (5,560/24,015) had systolic HF. The overall in-hospital mortality rate among hospitalized STEMI-CABG patients was 6.48% (1555/24,015). Among those with systolic HF, the in-hospital mortality rate was significantly higher at 8.18% (454/5560, p=0.01). After adjusting for possible confounders, concomitant systolic HF among hospitalized STEMI-CABG patients was not an independent predictor of overall in-hospital mortality (aOR 0.69; 95% CI, 0.40-1.21; p=0.20) and MCS utilization including percutaneous left ventricular assist device (aOR 1.51; 95% CI, 0.87-2.62; p=0.15), extracorporeal membrane oxygenation (aOR 1.12; 95% CI, 0.48-2.64; p=0.79), and intraaortic balloon pump (aOR 1.33; 95% CI, 0.98-1.76; p=0.06). However, systolic HF among hospitalized STEMI-CABG patients was found to be an independent predictor for the development of CS (aOR 1.68; 95% CI, 1.26-2.23; p=0.00) and longer LOS (aOR 1.86; 95% CI, 1.54-3.18; p=0.01). Our analysis showed that systolic HF among STEMI-CABG patients was not an independent predictor of increased in-hospital mortality and MCS utilization. However, it increased the risk for CS and longer LOS.
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