Abstract 9303: Delay in Coronary Artery Bypass Grafting for ST Elevated Acute Myocardial Infarction Patients is Associated With Beneficial Outcomes: Further Evidence and Opportunities

Abstract

Introduction: Coronary artery bypass grafting (CABG) surgery for patients with acute ST Elevated Acute Myocardial Infarction (STEMI) in the first 24 hrs of admission is associated with greater hospital morbidity and mortality. Delaying CABG >24 hrs may provide opportunities to improve patient outcomes. This study replicates and extends recent research and considers practice implications. Hypothesis: Patients with STEMI undergoing non-elective CABG surgery <24 hrs after admission will have worse outcomes than patients receiving later non-elective or elective CABG surgery. Methods: Patients age >= 30 yrs undergoing CABG <7 days of admission from the National Inpatient Sample 2016-2017 were examined. Non-elective and elective CABG was compared with 4 subgroups examined: Non-elective admission, STEMI diagnosis, CABG <24 hrs (Group A); CABG in 2-3 days (Group B); CABG in 4-7 days (Group C) and elective admission, CABG <7 days (Group D). Outcomes included postoperative complications (bleeding, cardiac, renal, respiratory), in-hospital mortality, post-operative and total hospital length of stay (LOS), and total hospital cost. Results: Patients with STEMI (n=2793, age=65.9±9.7 yrs) non-electively hospitalized (group A=47.2%, B=25.7% and C=27.0%) and elective admissions without STEMI (n=28096, mean=63.8 ±10.8 yrs, group D) were analyzed. Complication rates did not consistently differ for groups A, B, and C, however group A rates were significantly higher than group D. Group A had the highest mortality (6.06%) — significantly greater than groups B (3.62%) and C (3.32%) — with all non-elective groups greater than the elective group D (1.01%). Group A had significantly longer postoperative and total LOS. Total median hospitalization cost was lowest for elective group D ($135,446) but not significantly different between groups A ($191,344) and B ($203,944). Conclusions: STEMI cases typically need urgent intervention and CABG surgery can be critical for management. Delaying non-elective CABG >24 hours after admission is associated with better outcomes. Elective CABG has the best outcomes. More pre-surgical time provides opportunities to better prepare patients and caregivers with tailored coaching and content which can further improve outcomes.