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

BACKGROUND: There are limited contemporary data on the use of emergent coronary artery bypass grafting (CABG) in acute myocardial infarction. METHODS AND RESULTS: Adult (aged >18 years) acute myocardial infarction admissions were identified using the National (Nationwide) Inpatient Sample (2000–2...

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Autores principales: Patlolla, Sri Harsha, Kanwar, Ardaas, Cheungpasitporn, Wisit, Doshi, Rajkumar P., Stulak, John M., Holmes, David R., Bell, Malcolm R., Singh, Mandeep, Vallabhajosyula, Saraschandra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8475667/
https://www.ncbi.nlm.nih.gov/pubmed/33998286
http://dx.doi.org/10.1161/JAHA.120.020517
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author Patlolla, Sri Harsha
Kanwar, Ardaas
Cheungpasitporn, Wisit
Doshi, Rajkumar P.
Stulak, John M.
Holmes, David R.
Bell, Malcolm R.
Singh, Mandeep
Vallabhajosyula, Saraschandra
author_facet Patlolla, Sri Harsha
Kanwar, Ardaas
Cheungpasitporn, Wisit
Doshi, Rajkumar P.
Stulak, John M.
Holmes, David R.
Bell, Malcolm R.
Singh, Mandeep
Vallabhajosyula, Saraschandra
author_sort Patlolla, Sri Harsha
collection PubMed
description BACKGROUND: There are limited contemporary data on the use of emergent coronary artery bypass grafting (CABG) in acute myocardial infarction. METHODS AND RESULTS: Adult (aged >18 years) acute myocardial infarction admissions were identified using the National (Nationwide) 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 acute myocardial infarction 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% CI, 0.98–0.98]; P<0.001), in ST‐segment–elevation myocardial infarction (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 myocardial infarction (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 to 2017, compared with 2000 to 2005, admissions receiving emergent CABG were more likely to have non–ST‐segment–elevation myocardial infarction (80.5% versus 56.1%), higher rates of noncardiac multiorgan failure (26.1% versus 8.4%), cardiogenic shock (11.5% versus 6.4%), and use of mechanical circulatory support (19.8% versus 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 patients with ST‐segment–elevation myocardial infarction and non–ST‐segment–elevation myocardial infarction. An increase in lengths of hospital stay and hospitalization costs was seen over time. CONCLUSIONS: Utilization of CABG has decreased substantially in acute myocardial infarction admissions, especially in patients with ST‐segment–elevation myocardial infarction. Despite an increase in acuity and multiorgan failure, in‐hospital mortality consistently decreased in this population.
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spelling pubmed-84756672021-10-01 Temporal Trends, Clinical Characteristics, and Outcomes of Emergent Coronary Artery Bypass Grafting for Acute Myocardial Infarction in the United States Patlolla, Sri Harsha Kanwar, Ardaas Cheungpasitporn, Wisit Doshi, Rajkumar P. Stulak, John M. Holmes, David R. Bell, Malcolm R. Singh, Mandeep Vallabhajosyula, Saraschandra J Am Heart Assoc Original Research BACKGROUND: There are limited contemporary data on the use of emergent coronary artery bypass grafting (CABG) in acute myocardial infarction. METHODS AND RESULTS: Adult (aged >18 years) acute myocardial infarction admissions were identified using the National (Nationwide) 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 acute myocardial infarction 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% CI, 0.98–0.98]; P<0.001), in ST‐segment–elevation myocardial infarction (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 myocardial infarction (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 to 2017, compared with 2000 to 2005, admissions receiving emergent CABG were more likely to have non–ST‐segment–elevation myocardial infarction (80.5% versus 56.1%), higher rates of noncardiac multiorgan failure (26.1% versus 8.4%), cardiogenic shock (11.5% versus 6.4%), and use of mechanical circulatory support (19.8% versus 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 patients with ST‐segment–elevation myocardial infarction and non–ST‐segment–elevation myocardial infarction. An increase in lengths of hospital stay and hospitalization costs was seen over time. CONCLUSIONS: Utilization of CABG has decreased substantially in acute myocardial infarction admissions, especially in patients with ST‐segment–elevation myocardial infarction. Despite an increase in acuity and multiorgan failure, in‐hospital mortality consistently decreased in this population. John Wiley and Sons Inc. 2021-07-21 /pmc/articles/PMC8475667/ /pubmed/33998286 http://dx.doi.org/10.1161/JAHA.120.020517 Text en © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Patlolla, Sri Harsha
Kanwar, Ardaas
Cheungpasitporn, Wisit
Doshi, Rajkumar P.
Stulak, John M.
Holmes, David R.
Bell, Malcolm R.
Singh, Mandeep
Vallabhajosyula, Saraschandra
Temporal Trends, Clinical Characteristics, and Outcomes of Emergent Coronary Artery Bypass Grafting for Acute Myocardial Infarction in the United States
title Temporal Trends, Clinical Characteristics, and Outcomes of Emergent Coronary Artery Bypass Grafting for Acute Myocardial Infarction in the United States
title_full Temporal Trends, Clinical Characteristics, and Outcomes of Emergent Coronary Artery Bypass Grafting for Acute Myocardial Infarction in the United States
title_fullStr Temporal Trends, Clinical Characteristics, and Outcomes of Emergent Coronary Artery Bypass Grafting for Acute Myocardial Infarction in the United States
title_full_unstemmed Temporal Trends, Clinical Characteristics, and Outcomes of Emergent Coronary Artery Bypass Grafting for Acute Myocardial Infarction in the United States
title_short Temporal Trends, Clinical Characteristics, and Outcomes of Emergent Coronary Artery Bypass Grafting for Acute Myocardial Infarction in the United States
title_sort temporal trends, clinical characteristics, and outcomes of emergent coronary artery bypass grafting for acute myocardial infarction in the united states
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8475667/
https://www.ncbi.nlm.nih.gov/pubmed/33998286
http://dx.doi.org/10.1161/JAHA.120.020517
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