Optimal Timing of Coronary Artery Bypass Grafting in Patients with NSTEMI – A National Study from The United States

Authors

• Viet Nghi Tran, Marshall University Joan C. Edwards School of Medicine, Huntington, VW, USAFollow
• Hoang Nhat Pham, The University of Arizona, Tucson, AZ, USAFollow
• Ramzi Ibrahim, Mayo Clinic, Phoenix, AZ, USAFollow
• Hong Hieu Truong, Ascension Saint Francis, Evanston, IL, USAFollow
• Mahmoud Abdelnabi, Mayo Clinic, Phoenix, AZ, USAFollow
• Amreen Dhindsa, Weiss Memorial Hospital, Chicago, IL, USAFollow
• Pham Thao Vy Le, Methodist Hospital, Merrillville, IN, USAFollow
• Doan Ngoc Chau Nguyen, Texas Tech University Health Science Center, Amarillo, TX, USAFollow
• Aisha Jamal, Marshall University Joan C. Edwards School of Medicine, Huntington, VW, USAFollow
• Phillip Tran, Nam Can Tho University, Can Tho, Viet NamFollow
• Thach Nguyen, Methodist Hospital, Merrillville, IN, USAFollow
• Anwar Chahal, Mayo Clinic, Rochester, MN, USAFollow
• Kwan S. Lee, Mayo Clinic ArizonaFollow
• Reza Arsanjani, Mayo Clinic, Phoenix, AZ, USAFollow
• Amitoj Singh, Sarver Heart Center, University of Arizona, Tucson, AZFollow

Author Credentials

Viet Nghi Tran MD, Hoang Nhat Pham MD, Ramzi Ibrahim MD, Hong Hieu Truong MD, Mahmoud Abdelnabi MBBCh MSc, Amreen Dhindsa MD, Pham Thao Vy Le MD, Chau Doan Nguyen MD, Aisha Jamal MD, Amitoj Singh MD, Phillip Tran DO, Thach Nguyen MD, Anwar Chahal MD PhD, Kwan Lee MD, Reza Arsanjani MD

Author ORCID Identifier

Viet Nghi Tran: https://orcid.org/0000-0002-3834-9991

Keywords

time-to-cabg, optimal timing, cabg, nstemi, acute myocardial infarction, in-hopital mortality, cardiac arrest, ischemic stroke, cardiogenic shock, acute kidney injury, blood transfusion, length of stay, hospital charges

Disciplines

Medicine and Health Sciences

Abstract

Background: The timing of coronary artery bypass grafting (CABG) in patients with non-ST-elevation myocardial infarction (NSTEMI) may critically impact clinical outcomes, yet the ideal surgical window remains unclear. We aimed to evaluate the association between time-to-CABG and in-hospital outcomes among NSTEMI admissions undergoing CABG.

Methods: This retrospective cohort study utilized the US National Inpatient Sample database from 2017 to 2021 to evaluate the association between time-to-CABG and key in-hospital outcomes, including mortality, cardiac arrest, cardiogenic shock, ischemic stroke, acute kidney injury, and blood transfusion rates, while assessing length of stay (LOS) and hospital charges exclusively among survivors. Adult admissions with principal diagnosis of NSTEMI who underwent CABG without prior interhospital transfer were grouped by the calendar day of CABG from admission (0, 1, 2, 3, 4, 5, 6, and ≥7). Multivariate regression models were used to assess the outcomes across these eight groups.

Results: Of 142,200 included admissions, same-day CABG (hospital day 0) was associated with the highest rates of in-hospital mortality, cardiac arrest, cardiogenic shock, and ischemic stroke. The adjusted odds of mortality, cardiac arrest, and cardiogenic shock were lower among admissions undergoing CABG between days 2 and 5. Likewise, the adjusted odds of ischemic stroke were lowest when CABG occurred on days 2 to 4. The odds of AKI increased when CABG was delayed beyond day 6, whereas blood transfusion rates showed no statistically significant association with time-to-CABG. Among survivors, LOS and hospital charges progressively increased with delayed CABGs.

Conclusions: Among NSTEMI admissions undergoing CABG, CABG performed on hospital days 2 to 4 was associated with lower adjusted odds of several adverse in-hospital outcomes compared with same-day CABG. Further prospective studies are needed to validate these results and guide clinical decision-making.

Recommended Citation

Tran V, Pham H, Ibrahim R, et al. Optimal Timing of Coronary Artery Bypass Grafting in Patients with NSTEMI – A National Study from The United States. Marshall J Med. 2026; 12(2) DOI: https://doi.org/10.33470/2379-9536.1509.