Elbaz-Greener Gabby, Rozen Guy, Kusniec Fabio, Marai Ibrahim, Ghanim Diab, Carasso Shemy, Gavrilov Yulia, Sud Maneesh, Strauss Bradley, Ko Dennis T, Wijeysundera Harindra C, Planer David, Amir Offer
Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel; Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Am J Cardiol. 2020 Nov 1;134:32-40. doi: 10.1016/j.amjcard.2020.08.019. Epub 2020 Aug 15.
Up to 10% of non-ST-segment elevation myocardial infarction (NSTEMI) patients require coronary artery bypass graft (CABG) surgery during their hospitalization. Contemporary, real-world, data regarding CABG utilization and safety in NSTEMI patients are lacking. Our objectives were to investigate the contemporary trends in utilization and outcomes of CABG in patients admitted for NSTEMI. Using the 2003 to 2015 National Inpatient Sample data, we identified hospitalizations for NSTEMI, during which a CABG was performed. Patients' sociodemographic and clinical characteristics, incidence of surgical complications, length of stay, and mortality were analyzed. Multivariate analyses were performed to identify predictors of in-hospital complications and mortality. An estimated total of 440,371 CABG surgeries, during a hospitalization for NSTEMI, were analyzed. The utilization of CABG was steady over the years. The data show increasing prevalence of individual co-morbidities as well as cases with Deyo Co-morbidity Index ≥2 (p <0.001). High, 26.4%, complication rate was driven mainly by cardiac and pulmonary complications. The mortality rate declined from 3.6% in 2003 to an average of 2.4% during 2010 to 2015. Older age, female gender, heart failure, and delayed CABG timing were independent predictors of adverse outcomes. In conclusion, utilization of in-hospital CABG as the primary revascularization strategy in patients with NSTEMI remained steady over the years. These data reveal the raising prevalence of co-morbidities during the study. High complication rate was recorded; however, the mortality declined over the years to about 2.4%. Delaying CABG was associated with small but statistically significant worsening in outcomes.
高达10%的非ST段抬高型心肌梗死（NSTEMI）患者在住院期间需要进行冠状动脉旁路移植术（CABG）。目前缺乏关于NSTEMI患者CABG使用情况和安全性的当代真实世界数据。我们的目标是调查因NSTEMI入院患者CABG的当代使用趋势和结局。利用2003年至2015年全国住院患者样本数据，我们确定了进行CABG的NSTEMI住院病例。分析了患者的社会人口统计学和临床特征、手术并发症发生率、住院时间和死亡率。进行多变量分析以确定院内并发症和死亡率的预测因素。共分析了估计440371例因NSTEMI住院期间进行的CABG手术。多年来CABG的使用情况保持稳定。数据显示个体合并症以及Deyo合并症指数≥2的病例患病率增加（p<0.001）。高达26.4%的高并发症发生率主要由心脏和肺部并发症导致。死亡率从2003年的3.6%下降到2010年至2015年期间的平均2.4%。年龄较大、女性、心力衰竭和CABG时机延迟是不良结局的独立预测因素。总之，多年来在NSTEMI患者中使用院内CABG作为主要血运重建策略保持稳定。这些数据揭示了研究期间合并症患病率的上升。记录到高并发症发生率；然而，多年来死亡率下降到约2.4%。延迟CABG与结局虽小但有统计学意义的恶化相关。
