JTCS Speed Up Your Browser
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Lois U. Nwakanma
David D. Yuh
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Weiss, E. S.
Right arrow Articles by Yuh, D. D.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Weiss, E. S.
Right arrow Articles by Yuh, D. D.
Related Collections
Right arrow Congenital - acyanotic
Right arrow Coronary disease

J Thorac Cardiovasc Surg 2008;135:503-511
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Optimal timing of coronary artery bypass after acute myocardial infarction: A review of California discharge data

Eric S. Weiss, MDa, David D. Chang, MBA, MPH, PhDb, David L. Joyce, MDa, Lois U. Nwakanma, MDa, David D. Yuh, MDa,*

a Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
b Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland

Received for publication June 30, 2007; revisions received October 6, 2007; accepted for publication October 19, 2007.

* Address for reprints: David D. Yuh, MD, Division of Cardiac Surgery, The Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 618, Baltimore, MD 21287. (Email: dyuh{at}csurg.jhmi.jhu.edu).

Objective: The optimal timing for coronary artery bypass grafting after acute myocardial infarction is not well established. The California Discharge Database facilitates the study of this issue by providing data from a large patient cohort free of institutional bias. We examine the timing of coronary artery bypass grafting after acute myocardial infarction on short-term outcomes.

Methods: We reviewed California Discharge Data to identify 40,159 patients who were hospitalized for acute myocardial infarction (day 0) and underwent subsequent coronary artery bypass grafting. Patients were stratified by the timing of coronary artery bypass grafting to "early" (days 0–2) and "late" groups (day 3 or later). The primary outcome variable was all-cause hospital mortality. Multiple logistic and linear regression and propensity analyses assessed the risk of adverse events, controlling for factors associated with preoperative clinical acuity, including the Charlson Comorbidity Index, shock, mechanical ventilation, and the use of intra-aortic balloon counterpulsation.

Results: Of 9476 patients identified, 4676 (49%) were in the early coronary artery bypass grafting group and 4800 (51%) were in the late coronary artery bypass grafting group. A total of 444 patients (4.7%) died during hospitalization, with a peak mortality rate of 8.2% among patients undergoing coronary artery bypass grafting on day 0, declining to a nadir of 3.0% among patients undergoing coronary artery bypass grafting on day 3. The mean time to coronary artery bypass grafting was 3.2 days. Patients undergoing early coronary artery bypass grafting experienced a higher mortality rate than those undergoing late coronary artery bypass grafting (5.6% vs 3.8%, P < .001). Early coronary artery bypass grafting was an independent predictor of mortality after controlling for clinical acuity and on propensity analysis (odds ratio 1.43, P = .003).

Conclusion: Patients undergoing coronary artery bypass grafting within 2 days of hospitalization for acute myocardial infarction experienced higher mortality rates than those undergoing coronary artery bypass grafting 3 or more days after acute myocardial infarction, independently of clinical acuity. This suggests that coronary artery bypass grafting may best be deferred for 3 or more days after admission for acute myocardial infarction in nonurgent cases.

Abbreviations and Acronyms AMI = acute myocardial infarction; CABG = coronary artery bypass graft; IABP = intra-aortic balloon pump; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; OR = odds ratio; PCI = percutaneous coronary intervention




This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
K. Fattouch, F. Guccione, P. Dioguardi, R. Sampognaro, E. Corrado, M. Caruso, and G. Ruvolo
Off-pump versus on-pump myocardial revascularization in patients with ST-segment elevation myocardial infarction: a randomized trial.
J. Thorac. Cardiovasc. Surg., March 1, 2009; 137(3): 650 - 656.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T. Fukui, T. Shimokawa, S. Manabe, S. Morita, and S. Takanashi
Prior inferior myocardial infarction has worse early outcomes in patients undergoing coronary artery bypass grafting than prior anterior myocardial infarction.
Ann. Thorac. Surg., February 1, 2009; 87(2): 475 - 480.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2008 by The American Association for Thoracic Surgery.