Timing of Coronary Artery Bypass Grafting in Acute Coronary Syndrome: A National Analysis

Abstract

BackgroundTiming of surgical revascularization for acute coronary syndrome remains debated. We assessed the impact of timing to coronary artery bypass grafting (CABG) on mortality and resource utilization in a national cohort. MethodsAdults admitted for acute coronary syndrome in the 2009-2018 National Inpatient Sample were grouped by time from coronary angiography to CABG (Δt): 0, 1-3, 4-7, and >7 days. Generalized linear models were fit to evaluate associations between Δt and in-hospital mortality and hospitalization costs. Timing and mortality of CABG for acute coronary syndrome were compared between high-performing hospitals (below the median risk adjusted mortality for all CABG and valve operations) and others. ResultsOf 444,065 patients, Δt = 0 days in 12.3%, Δt = 1-3 days in 57.3%, Δt = 4-7 days in 26.3%, and Δt > 7 days in 4.2%. Risk-adjusted mortality was greatest at Δt = 0 days (4.5%, 95% confidence interval [CI], 4.1%-4.9%) and Δt > 7 days (4.0%, 95% CI 3.4%-4.7%), but similar for operations performed at Δt = 1-3 days (1.8%, 95% CI 1.7%-1.9%) and Δt = 4-7 days (2.1%, 95% CI 1.9%-2.3%). Compared to Δt = 1-3 days, hospitalization costs were greater by $6,400 (95% CI $5,900-$6,900) for Δt = 4-7 days and $21,200 (95% CI $19,800-$22,600) for Δt > 7 days. High-performing hospitals had similar time to CABG as others (2 vs 2 days, P = .17), but lower mortality (0.9% vs 3.3%, P < .001). ConclusionsRevascularization on days 1-3 and 4-7 led to comparable in-hospital mortality, with greater rates on day 0 and after day 7. Costs were greater for revascularization at days 4-7 compared with days 1-3. These findings support the reduction of time to revascularization to 1-3 days when deemed clinically appropriate and feasible.