Short- and long-term outcomes of ST-segment elevation myocardial infarction treated with CABG: a population-based cohort study

Abstract

<p><strong>Objectives: </strong>To investigate the outcomes of patients with ST-elevation myocardial infarction (STEMI) who were treated with coronary artery bypass grafting (CABG) surgery.</p><p><strong>Design: </strong>Retrospective nationwide cohort study.</p><p><strong>Setting: </strong>Patients with STEMI in Finland who were treated with CABG between January 2004 and December 2018.</p><p><strong>Participants: </strong>1069 patients (mean age: 66.4, 21.4% women).</p><p><strong>Primary outcome measure: </strong>All-cause mortality (median follow-up 6.4 years) and usage of evidence-based secondary preventive medication early after CABG.</p><p><strong>Results: </strong>In-hospital mortality among the total cohort was 10.0%, with a significant decrease (p<0.0001) during the study period. Cumulative 10-year mortality was 38.3%. Age, diabetes, renal disease, early surgery, usage of only venous grafts and concomitant procedures were associated with in-hospital mortality in multivariable modelling. Age, cerebrovascular disease, diabetes, heart failure, peripheral vascular disease, rheumatic disease and venous-only grafts were associated with 10-year mortality. Statins and beta blockers were used by >90% of patients and ACE inhibitors/angiotensin II receptor blockers by 70% of patients after discharge from the hospital. The proportion of high-dose statin users increased from 33.1% in 2004-2008 to 63.1% in 2014-2018. ADP inhibitors were used by 29.0% of patients, but the proportion increased during the study.</p><p><strong>Conclusions: </strong>Contemporary in-hospital and long-term outcomes of CABG-treated patients with STEMI are acceptable. In-hospital mortality has decreased, and the usage of secondary prevention medications after CABG procedures has increased in recent years.</p>