Outcomes After ST-segment Versus Non-ST-segment Elevation Myocardial Infarction Revascularized By Coronary Artery Bypass Grafting.

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The objectives of this study were to investigate the outcome differences between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients treated with coronary artery bypass grafting surgery (CABG). We conducted a multicenter, retrospective cohort follow-up study of consecutive patients with STEMI (surgery ≤48 hours of admission; n=348) or NSTEMI (n=1160) revascularized with first-time isolated CABG in Finland using nationwide registries (median age 68 years, 24% women). The short- and long-term (10-year) outcomes were studied with inverse propensity probability weight adjustment for baseline features. The median follow-up was 5.2 years. In-hospital mortality (11.4% vs. 5.3%; adj. OR 2.27; CI 1.41-3.66; p=0.001) and re-sternotomy rates (6.9% vs. 3.5%; adj. OR 2.07; CI 1.22-3.51; p=0.007) were higher in STEMI patients. Long-term all-cause mortality did not differ between STEMI and NSTEMI patients among all operated patients (30.2% vs. 28.3%; adj. HR 1.30; CI 0.97-1.75; p=0.080) or hospital survivors (21.6 vs. 24.3%; HR 0.93; CI 0.64-1.36; p=0.713). Occurrence of major adverse cardiovascular event in hospital survivors within 10-years was 34.7% in STEMI vs. 29.6% in NSTEMI (adj. HR 1.24; CI 0.88-1.76; p=0.220). Occurrences of cardiovascular death (14.6% vs. 14.4%; p=0.773), myocardial infarction (MI) (15.2% vs. 10.3%; p=0.203), and stroke (10.8% vs. 14.8%; p=0.242) were also comparable. In conclusion, patients with STEMI have poorer short-term outcome compared to NSTEMI patients after revascularization by CABG, but the long-term outcomes are comparable regardless of MI type. Thus, both short- and long-term risks should be considered when evaluating patient´s for CABG eligibility by MI type.


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