Abstract
OBJECTIVES: Approximately 5%-10% of ST-segment elevation myocardial infarction (STEMI) patients will undergo coronary artery bypass grafting (CABG) during the same hospital admission. In this study, we analyse the time from STEMI to CABG and its impact on operative mortality, morbidity, hospital stay, and cost. METHODS: The Healthcare Cost and Utilization Project (HCUP) was reviewed for STEMI patients who underwent CABG in the same hospitalization from 2016 to 2022. Patients were grouped by time from STEMI to CABG: <48 hours, 2-7 days, 8-15 days, and ≥16 days. Demographics, characteristics, mortality, length of stay, and cost were compared with univariable analysis. Multivariable logistic regression identified risk factors for in-hospital mortality. RESULTS: HCUP database identified 11 974 patients who underwent CABG following STEMI: 4882 < 48 hours (41%), 6110 in 2-7 days (51%), 896 in 8-15 days (7%), and 86 ≥ 16 days in (1%). Mortality was greatest when CABG performed <48 hours (6%) and ≥16 days (5%) compared to other groups 3% (2-7 days) vs 3% (8-15 days), P <.01. Length of stay was greatest in ≥16 days (30 days) compared to other groups 7 days (<48 hours) vs 10 days (2-7 days) vs 17 days (8-15 days), P < .01. Costs were also greatest in the ≥16 days ($108 400) compared to other groups ($50 400 [<48 hours] vs $55 300 [2-7 days] vs $73 600 [8-15 days], P < .01). Multivariable regression identified 2-7 days STEMI to CABG decreased in-hospital mortality (odds ratio [OR] 0.585, CI95% 0.48-0.70). CONCLUSIONS: CABG performed 2-15 days from STEMI provided the lowest in-hospital mortality risk, offering a window for the safest post-STEMI CABG when appropriate.