Timing of nonemergent coronary artery bypass grafting and mortality after non-ST elevation acute coronary syndrome.

BACKGROUND

The purpose of this study was to determine the association between time to coronary artery bypass grafting (CABG) and mortality among patients admitted with non-ST elevation acute coronary syndrome (NSTEACS). Patients are increasingly being referred for CABG soon after NSTEACS, although few data exist to guide the optimal timing of bypass surgery.

METHODS

We identified a cohort of all patients who underwent nonemergent CABG within 60 days of hospitalization for NSTEACS in the province of Alberta, Canada, from 2000 to 2004. Time from admission to CABG was categorized as early (2-7 days), intermediate (8-14 days), or late (15-60 days-reference group). The primary outcome was mortality occurring within 30 days of surgery.

RESULTS

Of the total cohort of 1,454 patients, 213 (14.6%) underwent early, 637 (43.8%) underwent intermediate, and 707 (48.6%) underwent late CABG surgery. In the final adjusted model time to CABG was not statistically significant as an independent predictor of short-term mortality. Compared to late CABG, there was a nonsignificant increased risk of mortality for those undergoing early (hazard ratio 2.36, 95% CI 0.72-7.76) and intermediate (hazard ratio 1.68, 95% CI 0.76-3.72) CABG surgery.

CONCLUSIONS

Time from admission to CABG was not associated with an increased risk of short-term mortality. However, there was a trend toward increased mortality with early CABG, and this study does not exclude the presence of a modest risk association between timing of CABG and short-term mortality.