Timing of Coronary Artery Bypass Grafting After Myocardial Infarction Influences Late Survival

Objectives The role of timing of coronary artery bypass grafting (CABG) after acute myocardial infarction (AMI) on early and late outcomes remains uncertain. Methods We reviewed 1,631 consecutive adult patients who underwent isolated CABG with information on timing of AMI. Early and late mortality were compared between patients receiving CABG within 24 hours after AMI, between 1-7 days after AMI and later than 7 days after AMI. Sensitivity analyses were performed in subgroups of patients with ST-segment elevation AMI (STEMI), non-ST-segment elevation AMI (NSTEMI), and other high-risk groups. Results A total of 124 (5.7%) patients underwent CABG within 24 hours, 972 (51.2%) received CABG between 1-7 days after AMI, and 535 (43.2%) patients had a CABG more than 7 days after AMI. Overall operative mortality was 2.7% with comparable adjusted early mortality between three groups. Over a median follow-up of 13.5 years (IQ 8.9-17.1), compared to patients receiving CABG between 1-7 days after AMI, those receiving CABG>7 days had greater adjusted risk for late overall mortality (HR 1.39, 95% CI 1.16-1.67; P<0.001), whereas those receiving CABG within 24 hours had comparable risk of late overall mortality (HR 1.12, 95% CI 0.86-1.47; P=0.39). Timing of CABG was associated with late mortality in NSTEMI, patients (CABG>7 days had higher risk of late mortality ((HR 1.38, 95% CI 1.14-1.67, P<0.001) compared to those receiving CABG between 1-7 days), but not in STEMI patients. Conclusions Early revascularization through CABG within 7 days during the same hospitalization appears beneficial, especially for patients presenting with NSTEMI.