title: Optimal Timing From Myocardial Infarction to Coronary Artery Bypass Grafting on Hospital Mortality.
abstract: BACKGROUND
  Whether delaying coronary artery bypass grafting (CABG) after myocardial infarction (MI) is associated with better outcomes or is an unnecessary use of health care resources is unclear. This study investigated the relationship between MI-to-CABG timing on in-hospital death.
  
  
  METHODS
  From the Northern New England Cardiovascular Disease Study Group (NNE) Cardiac Surgery Registry we identified 3,060 isolated CABG patients with prior MI from 2008 to 2014. We compared in-hospital death by MI-to-CABG timing of less than 1 day, 1 to 2 days, 3 to 7 days, and 8 to 21 days. We adjusted for patient characteristics using logistic regression.
  
  
  RESULTS
  Among patients with prior MI, CABG was performed within 1 day for 99 (3.2%), 1 to 2 days for 369 (12.1%), 3 to 7 days for 1,966 (64.3%), and 8 to 21 days for 626 (20.5%) patients. NNE-predicted mortality was similar for patients operated on within 1 day (1.8%), 1 to 2 days (1.8%), and 3 to 7 days (1.9%), but was higher for 8 to 21 days (2.4%) of MI. Crude in-hospital mortality was higher for those with MI-to-CABG time of less than 1 day (5.1%) compared with 1 to 2 days (1.6%), 3 to 7 days (1.6%), and 8 to 21 days (2.7%, p = 0.044). Adjusted in-hospital mortality remained high for less than 1 day (5.4%; 95% CI, 1.5% to 9.4%), and similar for 1 to 2 days (1.8%; 95% CI, 0.4% to 3.1%), 3 to 7 days (1.7%; 95% CI, 1.1% to 2.3%), and 8 to 21 days (2.3%; 95% CI, 1.2% to 3.3%) between MI and CABG.
  
  
  CONCLUSIONS
  Patients operated on 1 to 2 days and 3 to 7 days after MI had a similar mortality rate, suggesting it may be possible to reduce the MI-to-CABG interval for some patients without sacrificing outcomes. Patients operated on within 1 day after MI had a higher mortality rate.
authors: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon. Electronic address: elizabeth.l.nichols.gr@dartmouth.edu.
authors: Elizabeth L
authors: EL
authors: Nichols
authors: Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors: Jock N
authors: JN
authors: McCullough
authors: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon.
authors: Cathy S
authors: CS
authors: Ross
authors: Department of Surgery, Maine Medical Center, Portland, Maine.
authors: Robert S
authors: RS
authors: Kramer
authors: Department of Surgery, Catholic Medical Center, Manchester, New Hampshire.
authors: Benjamin M
authors: BM
authors: Westbrook
authors: Department of Surgery, Eastern Maine Medical Center, Bangor, Maine.
authors: John D
authors: JD
authors: Klemperer
authors: Department of Surgery, University of Vermont Medical Center, Burlington, Vermont.
authors: Bruce J
authors: BJ
authors: Leavitt
authors: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon; Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors: Jeremiah R
authors: JR
authors: Brown
authors: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon; Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors: Elaine
authors: E
authors: Olmstead
authors: Department of Surgery, Eastern Maine Medical Center, Bangor, Maine.
authors: Felix
authors: F
authors: Hernandez
authors: Department of Surgery, Concord Hospital, Concord, New Hampshire.
authors: Gerald L
authors: GL
authors: Sardella
authors: Department of Surgery, Central Maine Medical Center, Lewiston, Maine.
authors: Carmine
authors: C
authors: Frumiento
authors: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon; Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors: David
authors: D
authors: Malenka
authors: Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors: Anthony
authors: A
authors: DiScipio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D012042:Registries; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D061665:Time-to-Treatment / Q000592:standards*; D014481:United States / Q000453:epidemiology