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BACKGROUND: The impact of MI following CABG surgery on intensive care unit (ICU) time, hospital length of stay (LOS), and overall cost has not been thoroughly investigated. To determine the treatment-independent effect of MI within 4 days of CABG on ICU time, LOS, and costs, we analyzed a subset of patients from PRIMO-CABG, a double-blind, placebo-controlled trial comparing pexelizumab and placebo in patients (N=3099) undergoing CABG with cardiopulmonary bypass (CPB).
METHODS: Overall costs, LOS, and ICU time were correlated with the occurrence of MI within 4 days of CABG in those patients (n=2102) for whom cost data were available. MI was adjudicated by a blinded, clinical events committee and was defined as CK-MB >=100ng/ml or Q-wave MI with CK-MB >=70ng/ml. Patients in the trial had one or more of the following risk factors: female gender, repeat CABG, diabetes, urgent intervention, or history of MI, congestive heart failure, or neurological event
RESULTS: 9.1% of patients (n=191/2102) experienced an MI within 4 days of CABG. MI was associated with a 103% increase in ICU time (P<0.0001) and a 48% increase in LOS (P<0.0001). Similarly, hospital admission fees and total baseline costs increased by 43% (P<0.0001) and 42% (P<0.0001), respectively.
CONCLUSIONS: CK-MB should be routinely measured; MI within 4 days of CABG is associated with a significant increase in ICU time, LOS, and overall costs.