Delaying CABG Surgery Does Not Benefit NSTEMI Patients

Risk of adverse outcomes is same in patients undergoing early, late procedure
By Monica Smith
HealthDay Reporter

THURSDAY, April 22 (HealthDay News) -- Although most non-ST-segment elevation myocardial infarction (NSTEMI) patients undergo late coronary artery bypass graft (CABG) surgery after arriving at a hospital, they do not have improved outcomes compared with patients who undergo early CABG, despite having higher-risk clinical characteristics, according to research published in the April issue of the Journal of the American College of Cardiology: Cardiovascular Interventions.

Shailja V. Parikh, M.D., of the University of Texas Southwestern Medical Center in Dallas, and colleagues evaluated timing and rates of CABG among NSTEMI patients treated at U.S. hospitals from 2002 to 2008. They analyzed the clinical characteristics and outcomes of early versus late CABG in 825 patients who received the procedure early (in 48 hours or less) and 1,822 patients who received it late (after 48 hours).

The researchers found both rate (11 to 13 percent) and timing (30 percent early, 70 percent late) of CABG consistent during the study period, with the late-procedure patients tending to have a higher risk profile. In-hospital mortality (3.6 versus 3.8 percent) and the composite outcome of death, myocardial infarction, congestive heart failure, or cardiogenic shock (12.6 versus 12.4 percent) were similar between early- and late-procedure patients.

"Although [the late-procedure] patients have higher-risk clinical characteristics, they have the same risk of adverse clinical outcomes compared with patients who undergo early CABG. Thus, delaying CABG routinely after NSTEMI might increase resource use without improving outcomes," the authors write.

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