scholarly journals Temporal Trends, Clinical Characteristics and Outcomes of Emergent Coronary Artery Bypass Grafting for Acute Myocardial Infarction in the United States

2021 ◽  
Author(s):  
Sri Harsha Patlolla ◽  
Ardaas Kanwar ◽  
Wisit Cheungpasitporn ◽  
Rajkumar P Doshi ◽  
John M Stulak ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Artery Bypass ◽  
Temporal Trends ◽  
Bypass Grafting ◽  
St Segment Elevation ◽  
St Segment ◽  
Hospitalization Costs

Abstract Background There are limited contemporary data on the use of emergent coronary artery bypass grafting (CABG) in acute myocardial infarction (AMI). Methods and Results Adult (>18 years) AMI admissions were identified using the National 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 AMI 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% confidence interval {CI} 0.98‐0.98]; p<0.001), in ST‐segment‐elevation AMI (STEMI) (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 AMI (NSTEMI) (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 2012‐2017, compared to 2000‐2005, admissions receiving emergent CABG were more likely to have NSTEMI (80.5% vs. 56.1%), higher rates of non‐cardiac multiorgan failure (26.1% vs. 8.4%), cardiogenic shock (11.5% vs. 6.4%) and use of mechanical circulatory support (19.8% vs. 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 STEMI and NSTEMI. An increase in lengths of hospital stay and hospitalization costs was seen over time. Conclusions Utilization of CABG has decreased substantially in AMI admissions, especially in STEMI. Despite an increase in acuity and multi‐organ failure, in‐hospital mortality consistently decreased this population.

scholarly journals Temporal Trends, Predictors, and Outcomes of Acute Ischemic Stroke in Acute Myocardial Infarction in the United States

2021 ◽  
Author(s):  
Gaurav Aggarwal ◽  
Sri Harsha Patlolla ◽  
Saurabh Aggarwal ◽  
Wisit Cheungpasitporn ◽  
Rajkumar Doshi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Temporal Trends ◽  
St Segment Elevation ◽  
Endoscopic Gastrostomy ◽  
St Segment ◽  
Hospitalization Costs

Background There are limited contemporary data prevalence and outcomes of acute ischemic stroke (AIS) complicating acute myocardial infarction (AMI). Methods and Results Adult (>18 years) AMI admissions using the National Inpatient Sample database (2000–2017) were evaluated for in‐hospital AIS. Outcomes of interest included in‐hospital mortality, hospitalization costs, length of stay, discharge disposition, and use of tracheostomy and percutaneous endoscopic gastrostomy. The discharge destination was used to classify survivors into good and poor outcomes. Of a total 11 622 528 AMI admissions, 183 896 (1.6%) had concomitant AIS. As compared with 2000, in 2017, AIS rates increased slightly among ST‐segment–elevation AMI (adjusted odds ratio, 1.10 [95% CI, 1.04–1.15]) and decreased in non–ST‐segment–elevation AMI (adjusted odds ratio, 0.47 [95% CI, 0.46–0.49]) admissions ( P <0.001). Compared with those without, the AIS cohort was on average older, female, of non‐White race, with greater comorbidities, and higher rates of arrhythmias. The AMI‐AIS admissions received less frequent coronary angiography (46.9% versus 63.8%) and percutaneous coronary intervention (22.7% versus 41.8%) ( P <0.001). The AIS cohort had higher in‐hospital mortality (16.4% versus 6.0%; adjusted odds ratio, 1.75 [95% CI, 1.72–1.78]; P <0.001), longer hospital length of stay, higher hospitalization costs, greater use of tracheostomy and percutaneous endoscopic gastrostomy, and less frequent discharges to home (all P <0.001). Among AMI‐AIS survivors (N=153 318), 57.3% had a poor functional outcome at discharge with relatively stable temporal trends. Conclusions AIS is associated with significantly higher in‐hospital mortality and poor functional outcomes in AMI admissions.

Abstract 13993: Impact of Prasugrel Pretreatment and Timing of Coronary Artery Bypass Grafting on Clinical Outcomes of Patients With Non-ST-Segment Elevation Myocardial Infarction: From the Accoast Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Dariusz Dudek ◽  
Petr Widimsky ◽  
Leonardo Bolognese ◽  
Patrick Goldstein ◽  
Christian Hamm ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Clinical Outcomes ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Cabg Patients ◽  
The Impact

Objectives: We evaluated the impact of prasugrel pretreatment and timing of coronary artery bypass grafting (CABG) on clinical outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing CABG based on data from ACCOAST. Methods: We evaluated the impact of troponin, prasugrel pretreatment and CABG timing on clinical outcomes of NSTEMI patients undergoing CABG through 30 days from ACCOAST. Results: CABG patients versus PCI or medically managed patients were more often male, diabetic, had peripheral arterial disease and a higher GRACE score. By randomization assignment, 157 patients received a 30-mg loading-dose of prasugrel before CABG; 157 patients did not. CABG patients were grouped by tertiles of time from randomization to CABG; baseline characteristics in the Table. Patients in the lowest tertile had significantly more events (cardiovascular death, MI, stroke, urgent revascularization or glycoprotein IIb/IIIa bailout) and all TIMI major bleeds than those in the other 2 groups (p<0.045, p<0.002 respectively), but the patients in the higher 2 groups were not significantly different from each other. No difference was detected in all cause death among the 3 groups (p>0.39). A multivariate model evaluated 5 possible predictors of the composite endpoint of all cause death, MI, stroke and TIMI major bleeding. Time from randomization to CABG (HR 0.84 for each 1 hour of delay), left main disease presence (HR 1.76), and region of enrollment (Eastern Europe vs other, HR 3.83) were significant predictors but not prasugrel pretreatment or baseline troponin level ≥3xULN. Conclusions: In this group of high-risk patients presenting with NSTEMI, early surgical revascularization carried an increased risk of bleeding and ischemic complications, without impact on all-cause mortality. No impact of baseline troponin or prasugrel pretreatment (important factors influencing time of CABG) on clinical outcomes was confirmed.

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