title: Does Timing of Coronary Artery Bypass Surgery Affect Early and Long-Term Outcomes in Patients With Non-ST-Segment-Elevation Myocardial Infarction?
abstract: BACKGROUND
  Current guidelines do not provide recommendations for optimal timing of coronary artery bypass surgery (CABG) in patients with non-ST-segment-elevation myocardial infarction. Our study aimed to determine the impact of CABG timing on early and late outcomes in patients with non-ST-segment-elevation myocardial infarction.
  
  
  RESULTS
  A total of 758 patients underwent CABG within 21 days after non-ST-segment-elevation myocardial infarction between January 2008 and December 2012 at our institution. The patients were divided into 3 groups according to the time interval between symptom onset and CABG: group A, <24 hours (133 patients); group B, 24 to 72 hours (192 patients); and group C, >72 hours to 21 days (433 patients). Predictors of in-hospital and long-term mortality were identified by logistic and Cox regression analyses, respectively. Overall in-hospital mortality was 5.1% (39 patients): 6.0%, 4.7%, and 5.1% in groups A, B, and C (P=0.9), respectively. A total of 118 patients died during follow-up. The 5-year survival was 73.1±2%, with a nonsignificant trend toward better survival in groups A (78.2±4%) and C (75.4±3%) compared with group B (63.6±5%; log-rank P=0.06). Renal insufficiency and LMD were independent predictors of in-hospital (odds ratio, 3.1; P=0.001; and odds ratio, 3.1; P=0.002) and long-term mortality (hazard ratio, 1.7; P=0.004; and hazard ratio, 1.5; P=0.02), whereas administration of P2Y12 inhibitors was protective (odds ratio, 0.3; P=0.01).
  
  
  CONCLUSIONS
  Emergent CABG within 24 hours of non-ST-segment-elevation myocardial infarction is associated with in-hospital mortality and long-term outcomes similar to those of CABG performed after 3 days, despite a higher risk profile. CABG performed between 24 to 72 hours showed a nonsignificant trend toward poorer long-term outcomes. Dual antiplatelet therapy until surgery is beneficial, whereas renal insufficiency and left main disease increase the risk of early and late death.
authors: From the Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., A.V., S.L., M.M., F.W.M.); and Department of Cardiac Surgery, Columbia University, New York, NY (M.A.B.). pirarm@hotmail.com.
authors: Piroze M
authors: PM
authors: Davierwala
authors: From the Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., A.V., S.L., M.M., F.W.M.); and Department of Cardiac Surgery, Columbia University, New York, NY (M.A.B.).
authors: Alexander
authors: A
authors: Verevkin
authors: From the Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., A.V., S.L., M.M., F.W.M.); and Department of Cardiac Surgery, Columbia University, New York, NY (M.A.B.).
authors: Sergey
authors: S
authors: Leontyev
authors: From the Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., A.V., S.L., M.M., F.W.M.); and Department of Cardiac Surgery, Columbia University, New York, NY (M.A.B.).
authors: Martin
authors: M
authors: Misfeld
authors: From the Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., A.V., S.L., M.M., F.W.M.); and Department of Cardiac Surgery, Columbia University, New York, NY (M.A.B.).
authors: Michael A
authors: MA
authors: Borger
authors: From the Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., A.V., S.L., M.M., F.W.M.); and Department of Cardiac Surgery, Columbia University, New York, NY (M.A.B.).
authors: Friedrich W
authors: FW
authors: Mohr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: coronary artery bypass; coronary artery disease; morbidity; mortality; myocardial infarction; survival analysis