Medical Student University of British Columbia Victoria, British Columbia, Canada
Background: Revascularization is the cornerstone of Non-ST-Elevation Myocardial Infarction (NSTEMI) management, with coronary artery bypass graft (CABG) the recommended modality in cases with certain anatomic or comorbid features. Retrospective analyses have found an increasing risk of mortality with delay of CABG beyond an initial 2 day delay from the time of coronary angiography (Cath). We investigated the status quo and historical trend in Cath-to-CABG time following hospitalization for NSTEMI, and compared it against the reference standard of 3 to 7 days reported in the literature.
METHODS AND RESULTS: We linked data from the British Columbia Discharge Abstract Database and Medical Services Plan billing records using the provincial Ministry of Health Data Platform. We included records of 6,771 CABG procedures on all 6,771 patients aged 20-79 that were hospitalized with primary diagnosis code of NSTEMI, received diagnostic Cath, and underwent CABG, in that order. The data spanned the fifteen year period of 2010 through 2024.
We analyzed the distribution of observed Cath-to-CABG times and the relative proportions of cases classified by risk strata reported in the literature (≤2 Days, 3-7 Days, 8-30 Days, ≥30 Days). A moving average of Cath-to-CABG time across the province demonstrated a cyclical pattern (simple linear regression trend of +0.08 days/year, P=.008). The data are visualized in Figure 1.
The identity of the treating Cardiac Surgeon was correlated with Cath-to-CABG time (R=0.224, P<.001), and average times varied widely across surgeons from 6.00 to 23.9 days. The referring Interventionalist was similarly correlated (R=0.220, P<.001). However, delays were correlated with local health area (R=0.193, P<.001), and varied even more widely across areas than practitioners, from 8.35 to 27.8 days. This suggests that variation in Cath-to-CABG time is more associated with local health area factors than individual practitioner effects.
Cath-to-CABG times were statistically significantly, but clinically insignificantly, correlated with total annual case volumes (R=0.042, P< 0.001).
Conclusion: British Columbia NSTEMI Cath-to-CABG times are nearing all-time highs, with 30.1% of NSTEMI CABG cases occurring 3 to 7 days after cardiac catheterization, down from 48.8% fifteen years earlier. The proportion of cases performed more than one week after catheterization has nearly doubled compared to 15 years ago.
