Abstract 19214: Critical Preoperative State and Left Main Disease and not Timing of Coronary Artery Bypass Surgery after non-ST-Elevation Myocardial Infarction Impact Early and Long-term Survival
Objective: According to the most recent guidelines, revascularization of patients with non-ST-elevation myocardial infarction (NSTEMI) by coronary artery bypass graft surgery (CABG) should generally be based on the same considerations as for those without NSTEMI. Our study aimed to determine the impact of timing of CABG on early and late outcomes in patients with NSTEMI and define the predictors of in-hospital (HM) and long-term mortality.
Patients and Methods: Demographic characteristics, preoperative risk factors, operative variables, and hospital outcomes were collected prospectively for 758 patients who underwent CABG within 21 days after NSTEMI between January 2008 and December 2012 at our institution. The patients were divided into three groups according to the time-interval between onset of NSTEMI and CABG: Group A: <24 hours (257 patients), Group B: 24-72 hours (130 patients), and Group C: >72 hours-21 days (371 patients). Predictors of HM and long-term mortality were identified by logistic and Cox regression analyses, respectively.
Results: The overall HM was 5.1%, being 5.4%, 4.6% and 5.1% in groups A, B, and C (p=0.1), respectively. Stepwise logistic regression analysis revealed critical preoperative state (odds ratio [OR]:3.1; 95% confidence interval [CI]:1.4-6.6; p=0.005), left main disease (OR:2.7; 95%CI:1.4-5.5; p=0.005), and peripheral vascular disease (OR:2.3; 95%CI:1.1-4.6; p=0.02) as independent predictors of HM.
Overall 5-year survival was 83±2%. The group-wise 5-year survival was 80±4%, 82±4%, and 84±2% for Groups A, B and C patients, respectively [log rank p=0.5]. Critical preoperative state (OR:2.2; 95%CI:1.4-3.6; p=0.001), left main disease (OR:1.5; 95%CI:1.0-2.2; p=0.05), peripheral vascular disease (OR:2.6; 95%CI:1.8-3.9; p=0.0001), and age (OR:1.1; 95%CI:1.0-1.1; p=0.0001) predicted long-term mortality.
Conclusions: CABG can be performed with an acceptable HM and excellent long-term survival in patients presenting with NSTEMI irrespective of the time interval between symptom-onset and revascularization. However, presence of a critical preoperative state, left main disease, and/or peripheral vascular disease negatively impacts both early and long-term outcomes.
Author Disclosures: P. Davierwala: None. A. Verevkin: None. S. Leontyev: None. M. Misfeld: None. M.A. Borger: None. F.W. Mohr: None.
- © 2014 by American Heart Association, Inc.