Ideal Timing of Coronary Artery Bypass Grafting After Non–ST-Segment Elevation Myocardial Infarction

Abstract

Background

Patients with non–ST-segment elevation myocardial infarction (NSTEMI) benefit from revascularization, but guidelines are vague regarding optimal timing. This study aimed to identify the ideal timing of coronary artery bypass grafting (CABG) after NSTEMI.

Methods

Study investigators examined patients with NSTEMI who underwent isolated CABG within 30 days of cardiac catheterization between July 2011 and July 2023 in a multicenter regional collaborative. Patients were stratified into 3 groups: ≤2 days, 3 to 7 days, and 8 to 30 days. Multivariable logistic regression analysis was performed to identify risk factors associated with mortality.

Results

Study investigators identified 10,271 patients who underwent CABG: 3464 (34%) of these patients underwent CABG within ≤2 days, 5751 (56%) at 3 to 7 days, and 1056 (10%) at 8 to 30 days. The 3- to 7-day group had the lowest median The Society of Thoracic Surgeons predicted risk of mortality (1.36% vs 1.35% vs 2.09%; P < .001). The ≤2-day group more frequently presented with left main coronary artery disease (19% vs 16% vs 16%; P < .001) and cardiogenic shock (5.1% vs 1.8% vs 2%; P < .001). Mean cardiopulmonary bypass time was similar among the groups (97 minutes vs 97 minutes vs 97 minutes; P = .63). The 3- to 7-day group had the lowest operative mortality (3.2% vs 1.8% vs 4%; P < .001) and major morbidity (14% vs 11% vs 16%; P < .001). After risk-adjustment, the 3- to 7-day window was associated with decreased mortality compared with ≤2 days (odds ratio [OR], 0.56; 95% CI, 0.4-0.78; P < .001) and 8 to 30 days (OR, 0.51; 95% CI, 0.32-0.81; P < .001).

Conclusions

CABG between 3 and 7 days after cardiac catheterization for NSTEMI was associated with the lowest risk of mortality. When possible, CABG within this window may afford better outcomes.