Ventricular arrhythmias and in-hospital outcomes in non-elective coronary artery bypass graft in type 1 myocardial infarction: An analysis of the national inpatient sample

ABSTRACT

Background: Malignant ventricular arrhythmias (VAs) are a serious complication of type 1 myocardial infarction (T1MI), yet their burden and impact on outcomes in patients undergoing urgent coronary artery bypass grafting (CABG) are not well established.

Objectives: We aim to identify the incidence and the prognostic impact of malignant VAs in patients undergoing non-elective CABG for T1MI.

Methods: A retrospective cohort study using the National Inpatient Sample from 2016 to 2022 was conducted by identifying all adult patients with T1MI who underwent non-elective CABG. Survey-weighted analyses were performed to compare baseline characteristics and outcomes between VAs and non-VAs groups. Multivariable logistic regression was used to evaluate the independent association between VAs and in-hospital mortality.

Results: Among 388,310 weighted hospitalizations for T1MI undergoing CABG, 10.0% had malignant VAs. Patients with VAs were younger (65.6 vs. 65.4 years, p < 0.01), less likely to be female (21.7% vs. 26.8%, p < 0.01), and had higher rates of comorbid conditions. The presence of VAs was associated with higher in-hospital mortality (11.2% vs. 2.7%), longer hospital stay (12 vs. 8 days), and increased incidence of acute kidney injury (40.9% vs. 27.8%, p < 0.01). After adjustment, VAs remained independently associated with increased odds of in-hospital mortality (aOR 2.90, 95% CI 2.62-3.21).

Conclusions: VAs occur around 10% in patients undergoing CABG for T1MI and are strongly associated with an increase in in-hospital mortality. These findings underscore the importance of perioperative monitoring and management of VAs in this high-risk population.

Keywords: Ventricular tachycardia, ventricular fibrillation, myocardial infarction, coronary artery bypass graft