Is It Time to Rethink Cardiac Surgery Requirements for Heart Attack Centers?

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Is It Time to Rethink Cardiac Surgery Requirements for Heart Attack Centers?
A new study reveals that emergency bypass surgery is rarely used to treat STEMI heart attack patients — even in hospitals specifically equipped for this purpose.

When Every Second Counts: Understanding STEMI and Emergency Care
ST-elevation myocardial infarction (STEMI) is a severe type of heart attack that demands rapid treatment. The most common solution is a procedure known as percutaneous coronary intervention (PCI), or angioplasty, where doctors open blocked arteries with balloons and stents. But what about bypass surgery — the more invasive coronary artery bypass grafting (CABG)? Once a more common emergency option, CABG has become increasingly rare for STEMI patients.

HMRI’s Chief Science Officer and Director of Cardiovascular Research, Robert A. Kloner, MD, PhD, published new research with collaborators from Los Angeles County in the “Western Journal of Emergency Medicine.” Their retrospective study, “Coronary Artery Bypass Grafting is Rarely Done in the Acute Care of ST-elevation Myocardial Infarction Patients Treated by Emergency Medical Services,” which spans over a decade, sheds light on the infrequent use of CABG in urgent STEMI care — and what that might mean for emergency departments are organized and equipped.

Researchers analyzed data from over 28,000 STEMI patients who were transported by emergency medical services (EMS) within a large, regional cardiac care network from 2011 to 2022. Each patient was taken to one of 34 STEMI receiving centers (SRCs) — hospitals specifically designated and required to have on-site cardiac surgery available.

The purpose of the research was to determine the number of patients who underwent urgent or emergent CABG (defined as surgery within 72 hours of their initial diagnostic procedure).

Key Findings

  • CABG is rare: Out of 28,349 STEMI patients, only 384 (1.35%) underwent urgent or emergent CABG.
  • Most were operated on swiftly: About 70% of those surgeries occurred within the first 24 hours.
  • Minimal change over time: Despite advancements in cardiac care, the rate of urgent CABG essentially remained unchanged over the 12-year study period — from 1.19% in 2011 to 1.96% in 2022.
  • PCI continues to lead: More than one-third of patients who underwent bypass surgery first received PCI, suggesting that CABG was employed as a fallback when PCI proved inadequate.

Why This Matters
These findings raise an important policy question: Should we continue to require all STEMI hospitals to have on-site cardiac surgery capabilities, given that fewer than 2% of patients with STEMI require emergency bypass surgery?

On-site surgery is costly and resource-intensive. If only a small percentage of STEMI patients utilize it, it may be time to reassess how heart centers are designated and equipped — especially in areas with limited healthcare resources.

Additionally, understanding which patients are most likely to need CABG could help EMS and hospitals better triage and customize care, potentially avoiding unnecessary delays or costs.

Looking Ahead
This study highlights how treatment trends have shifted — emergency bypass surgery is no longer the front-line response to STEMI that it once was. As emergency heart care continues to evolve, studies like this help inform policy to deliver the most appropriate life-saving interventions to patients — efficiently and equitably.

Source:
Coronary Artery Bypass Grafting Is Rarely Done in the Acute Care of ST-elevation Myocardial Infarction Patients Treated by Emergency Medical Services
Western Journal of Emergency Medicine
DOI: 10.5811/westjem.35271