Temporal trends, clinical characteristics, and outcomes of emergent coronary artery bypass grafting for acute myocardial infarction in the united states

Sri Harsha Patlolla, Ardaas Kanwar, Wisit Cheungpasitporn, Rajkumar P. Doshi, John M. Stulak, David R. Holmes, Malcolm R. Bell, Mandeep Singh, Saraschandra Vallabhajosyula

Research output: Contribution to journalArticlepeer-review


BACKGROUND: There are limited contemporary data on the use of emergent coronary artery bypass grafting (CABG) in acute myocardial infarction. METHODS AND RESULTS: Adult (aged >18 years) acute myocardial infarction admissions were identified using the National (Nationwide) Inpatient Sample (2000–2017) and classified by tertiles of admission year. Outcomes of interest included temporal trends of CABG use; age-, sex-, and race-stratified trends in CABG use; in-hospital mortality; hospitalization costs; and hospital length of stay. Of the 11 622 528 acute myocardial infarction admissions, emergent CABG was performed in 1 071 156 (9.2%). CABG utilization decreased overall (10.5% [2000] to 8.7% [2017]; adjusted odds ratio [OR], 0.98 [95% CI, 0.98–0.98]; P<0.001), in ST-segment–elevation myocardial infarction (10.2% [2000] to 5.2% [2017]; adjusted OR, 0.95 [95% CI, 0.95–0.95]; P<0.001) and non–ST-segment–elevation myocardial infarction (10.8% [2000] to 10.0% [2017]; adjusted OR, 0.99 [95% CI, 0.99–0.99]; P<0.001), with consistent age, sex, and race trends. In 2012 to 2017, compared with 2000 to 2005, admissions receiving emergent CABG were more likely to have non–ST-segment–elevation myocardial infarction (80.5% versus 56.1%), higher rates of noncardiac multiorgan failure (26.1% versus 8.4%), cardiogenic shock (11.5% versus 6.4%), and use of mechanical circulatory support (19.8% versus 18.7%). In-hospital mortality in CABG admissions decreased from 5.3% (2000) to 3.6% (2017) (adjusted OR, 0.89; 95% CI, 0.88–0.89 [P<0.001]) in the overall cohort, with similar temporal trends in patients with ST-segment–elevation myocardial infarction and non–ST-segment–elevation myocardial infarction. An increase in lengths of hospital stay and hospitalization costs was seen over time. CONCLUSIONS: Utilization of CABG has decreased substantially in acute myocardial infarction admissions, especially in patients with ST-segment–elevation myocardial infarction. Despite an increase in acuity and multiorgan failure, in-hospital mortality consistently decreased in this population.

Original languageEnglish (US)
Article numbere020517
JournalJournal of the American Heart Association
Issue number15
StatePublished - Aug 3 2021


  • Acute cardiovascular care
  • Acute myocardial infarction
  • Coronary artery bypass grafting
  • Epidemiology
  • Outcomes research

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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