Objectives: To investigate the outcomes of patients with ST-elevation myocardial infarction (STEMI) who were treated with coronary artery bypass grafting (CABG) surgery.

Design: Retrospective nationwide cohort study.

Setting: Patients with STEMI in Finland who were treated with CABG between January 2004 and December 2018.

Participants: 1069 patients (mean age: 66.4, 21.4% women).

Primary outcome measure: All-cause mortality (median follow-up 6.4 years) and usage of evidence-based secondary preventive medication early after CABG.

Results: In-hospital mortality among the total cohort was 10.0%, with a significant decrease (p<0.0001) during the study period. Cumulative 10-year mortality was 38.3%. Age, diabetes, renal disease, early surgery, usage of only venous grafts and concomitant procedures were associated with in-hospital mortality in multivariable modelling. Age, cerebrovascular disease, diabetes, heart failure, peripheral vascular disease, rheumatic disease and venous-only grafts were associated with 10-year mortality. Statins and beta blockers were used by >90% of patients and ACE inhibitors/angiotensin II receptor blockers by 70% of patients after discharge from the hospital. The proportion of high-dose statin users increased from 33.1% in 2004-2008 to 63.1% in 2014-2018. ADP inhibitors were used by 29.0% of patients, but the proportion increased during the study.

Conclusions: Contemporary in-hospital and long-term outcomes of CABG-treated patients with STEMI are acceptable. In-hospital mortality has decreased, and the usage of secondary prevention medications after CABG procedures has increased in recent years.