• Yi Pi, Matthew T Roe, DaJuanicia N Holmes, Karen Chiswell, J Lee Garvey, Gregg C Fonarow, James A de Lemos, Kirk N Garratt, and Ying Xian.
• From the Duke Clinical Research Institute, Durham, NC (Y.P., M.T.R., D.N.H., K.C., Y.X.); China Oxford Centre for International Health Research, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (Y.P.); Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC (J.L.G.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Center for Heart and Vascular Health, Christiana Care Health System, Newark, DE (K.N.G.). yi.pi@outlook.com.
• Circ Cardiovasc Qual. 2017 Aug 1; 10 (8).

BackgroundThere are limited data on the utilization and outcomes of coronary artery bypass grafting (CABG) among ST-segment-elevation myocardial infarction (STEMI) patients in contemporary practice.Methods And ResultsUsing data from National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines between 2007 and 2014, we analyzed trends in CABG utilization and hospital-level variation in CABG rates. Patients undergoing CABG during the index admission were categorized by the most common scenarios: (1) CABG only as the primary reperfusion strategy; (2) CABG after primary percutaneous coronary intervention; and (3) CABG after fibrinolytic therapy. A total of 15 145 patients (6.3% of the STEMI population) underwent CABG during the index hospitalization, with a decrease in utilization from 8.3% in 2007 to 5.4% in 2014 (trend P value <0.001). The hospital-level use of CABG in STEMI varied widely from 0.5% to 36.2% (median, 5.3%; interquartile range [IQR], 3.5%-7.8%; P value <0.001). Of all patients undergoing CABG, 45.8% underwent CABG only, 38.7% had CABG after percutaneous coronary intervention, and 8.2% CABG after fibrinolytic therapy. The median time intervals from cardiac catheterization/percutaneous coronary intervention to CABG were 23.3 hours (IQR, 3.0-70.3 hours) in CABG only, 49.7 hours (IQR, 3.2-70.3 hours) in CABG after percutaneous coronary intervention, and 56.6 hours (IQR, 22.7-96.0 hours) in CABG after fibrinolytic therapy. The Acute Coronary Treatment and Intervention Outcomes Network mortality risk scores differed modestly (median, 33; IQR, 28-40 versus median, 32; IQR, 27-38) between CABG and non-CABG patients. Patients undergoing CABG had similar in-hospital mortality rate (5.4% versus 5.1%) as those not treated with CABG.ConclusionsCABG is performed infrequently in STEMI patients during the index hospitalization, with rates declining in contemporary US practice over time. There was marked hospital-level variation in the use of CABG, and CABG was typically performed within 1 to 3 days after angiography. Observed mortality rates appear low, suggesting that CABG might be safely performed in select STEMI patients in a timely fashion.© 2017 American Heart Association, Inc.

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