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204. Ideal Timing of Coronary Artery Bypass Grafting after Non-ST Elevation Myocardial Infarction

April 28, 2024


Source:
104th Annual Meeting, Metro Toronto Convention Center, Toronto, ON, Canada
Metro Toronto Convention Center, Room 717
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Objective:
Patients presenting with a non-ST elevation myocardial infarction (NSTEMI) frequently benefit from coronary revascularization. Aside from those in extremis, current guidelines are vague as to the optimal timing of surgical intervention. We hypothesized that the ideal time for CABG after NSTEMI is 3-7 days after catheterization, with worse outcomes outside of this window.

Methods:
We examined patients admitted with an NSTEMI who underwent CABG within 30 days of cardiac catheterization between July 2011 and July 2023 using a multicenter regional collaborative database. Patients were stratified into three groups by time, defined as ≤2 days, 3-7 days, and 8-30 days. Linear and multivariable logistic regression analyses were performed to identify pre- and intraoperative predictors of wait time and operative mortality.

Results:
We identified 10,271 patients who underwent CABG after NSTEMI, of which 3,464 (34%) underwent CABG ≤2 days after catheterization, 5,751 (56%) between 3-7 days, and 1056 (10%) between 8-30 days. Patients who underwent CABG within 3-7 days had the lowest Society of Thoracic Surgeons predicted risk of mortality (1.36% vs. 1.35% vs. 2.09%, p<0.001). However, patients in the ≤2 day group were most likely to present with left main disease [657(19%) vs. 896(16%) vs. 171(16%)], cardiogenic shock [178(5.1%) vs. 101(1.8%) vs. 21(2%)], and require a preoperative intra-aortic balloon pump [715(21%) vs. 219(5.2%) vs. 47(4.5%), all p<0.001]. Cardiopulmonary bypass time was similar between groups (97 mins vs 97 vs 97, p=0.63). Patients in 3-7d group had the lowest operative mortality [111(3.2%) vs. 103(1.8%) vs. 42(4%)], major morbidity (484(14%) vs 657(11%) vs. 172(16%)], and shortest intensive care unit length of stay (52 hours vs. 51 vs. 65, all p<0.001) with those waiting 8-30 days having the highest rates. Higher STS-PROM scores were associated with a longer wait time (0.025 points, 95% CI 0.011-0.04, p=0.001). In the risk-adjusted analysis, the 3-7d group was associated with a decreased risk of operative mortality when compared to the ≤2 day group (OR 0.56, 95%CI 0.42-0.74, p<0.001) and 8-30 day group (OR 0.51, 95% CI 0.35-0.74, p<0.001).

Conclusion:
Risk adjusted patients who underwent CABG after an NSTEMI were at their lowest risk for operative mortality 3-7 days after cardiac catheterization. Care should be taken to optimize patients in a timely fashion to allow for CABG during this time window when feasible.


Anthony Norman (1), Matthew Weber (1), Mohamad El Moheb (2), Alexander Wisniewski (1), Raymond Strobel (1), Alan Speir (3), Michael Mazzeffi (4), Michael Kontos (5), Mark Joseph (6), Daniel Tang (7), Ramesh Singh (8), Mohammed Quader (5), Jared Beller (1), Kenan Yount (7), Nicholas Teman (9), (1) University of Virginia, Charlottesville, VA, (2) University of virginia, Charlottesville, VA, (3) Inova Heart and Vascular Institute, Fairfax, VA, (4) N/A, Baltimore, MD, (5) Virginia Commonwealth University, Richmond, VA, (6) N/A, Chapel Hill, NC, (7) N/A, N/A, (8) N/A, Falls Church, VA, (9) University of Virginia Health System, Crozet, VA


Patrick Myers

Commentator

Patrick Myers is a consultant cardiac surgeon at CHUV - Lausanne University Hospitals in Switzerland and Privat Docent at the Geneva University Medical School. After finishing medical school in Geneva, Patrick completed his cardiovascular surgery residency at the Geneva University Hospitals. He served as senior fellow in adult cardiac surgery at Brigham & Women’s Hospital and Harvard Medical School and then as fellow in cardiac surgery at Boston Children’s Hospital. He was appointed instructor in surgery at Boston Children’s Hospital & Harvard Medical School, before returning as attending surgeon in adult and congenital cardiac surgery in Geneva, Switzerland, where he was named associate of the chief of cardiac surgery. Since 2017, he has focused on adult cardiac surgery in his private practice in adult cardiac surgery in Geneva and serves as consultant cardiac surgeon at CHUV Lausanne. He has served as secretary of the European Board for Cardio-Thoracic Surgery, chair of the EACTS Acquired Cardiac Diseases Domain, Secretary General of EACTS since 2022, and president of CTSNet. His areas of interest are multiple arterial coronary artery bypass grafting, evolving transcatheter techniques to treat structural heart disease, HOCM and critical appraisal of clinical trials and their discussions on social media.

Anthony Norman

Abstract Presenter

I'm currently a general surgery resident at the University of Virginia with the plan to become a cardiothoracic surgeon. I grew up in Chelsea, MA. During my undergraduate and medical school studies in Boston, I partook in outcomes research in cardiac surgery and have continued to do so here at UVA. Currently during my professional development time, I'm working as a post-doctoral fellow studying ischemic reperfusion injury under Drs. Irving Kron, Victor Laubach and Mark Roeser as well as working to obtain a masters in clinical research.