CABG rates decline in patients admitted for acute MI
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The use of CABG has declined dramatically in MI admissions, particularly in STEMI, according to a presentation at the American College of Cardiology Scientific Session.
“In the contemporary era, PCI technologies have improved tremendously, and there has been a robust increase in the use of primary PCI for STEMI and urgent PCI for non-STEMI. In STEMI and non-STEMI with multivessel disease, patients often receive staged multivessel PCI. Therefore, the role of emergency CABG has diminished significantly in the contemporary era,” Saraschandra Vallabhajosyula, MD, MSc, interventional cardiology fellow at Emory University School of Medicine, told Healio.
The study was simultaneously published in the Journal of the American Heart Association.
“We sought to assess the national trends and outcomes of emergency CABG in this population. Though infrequently used, acute MI is a higher risk state than an elective CABG admission for stable ischemic heart disease, and therefore it is important to know the contemporary outcomes,” Vallabhajosyula said in an interview.
The researchers analyzed 11,622,528 acute MI admissions documented in the National Inpatient Sample from 2000 to 2017.
According to the researchers, CABG was performed in 9.2% of all acute MI admissions, with a decrease for STEMI admissions during the study period (2000, 10.5%; 2017, 8.7%; adjusted OR = 0.98; 95% CI, 0.98-0.98; P < .001).
The researchers found CABG use decreased both in STEMI (2000, 10.2%; 2017, 5.2; aOR = 0.95; 95% CI, 0.95-0.95; P < .001) and in non-STEMI (2000, 10.8%; 2017, 10%; aOR = 0.99; 95% CI, 0.99-0.99; P < .001).
Among patients with acute MI who had CABG, in-hospital mortality decreased from 5.3% in 2000 to 3.6% in 2017 (aOR = 0.89; 95% CI, 0.88-0.89; P < .001) in the overall cohort, with similar temporal trends in STEMI and non-STEMI, the researchers found.
“Over time, admissions receiving CABG had increasing incidence of noncardiac acute organ failure and cardiogenic shock, despite which, a steady and significant decline in in-hospital mortality after CABG was identified over the 18-year study period,” Vallabhajosyula said in an interview.
Reference:
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Vallabhajosyula S, et al. Multiple dimensions of risk reduction in ischemic heart disease. Presented at: American College of Cardiology Scientific Session; May 15-17, 2021 (virtual meeting).
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