Coronary artery bypass graft patients treated with primary percutaneous coronary intervention have high long-term adverse event rates (10 920 STEMI patients from the London Heart Attack Group)
Akhtar, M.M. Jones, Daniel A. Rathod, Krishnaraj S. Modi, B. Lim, Pitt Virdi, Gurkamal K. Bromage, Dan Jain, A.J. Singh Kalra, S. Crake, Tom
Akhtar, M.M.
Jones, Daniel A.
Rathod, Krishnaraj S.
Modi, B.
Lim, Pitt
Virdi, Gurkamal K.
Bromage, Dan
Jain, A.J.
Singh Kalra, S.
Crake, Tom
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Abstract
Background Limited information exists regarding procedural success
and clinical outcomes of ST-segment elevation myocardial infarction (STEMI) in patients with previous CABG undergoing primary
PCI. We sought to compare outcomes in STEMI patients undergoing primary percutaneous coronary intervention (PCI) with or
without previous coronary artery bypass grafts (CABG).
Methods This was an observational cohort study of 10,920 patients
with STEMI who were treated with PPCI between 2004 and 2011
at eight tertiary cardiac centres across London, UK. Patient’s details
were recorded at the time of the procedure into the British Cardiac
Intervention Society (BCIS) database. Outcome was assessed by
all-cause mortality. Anonymous datasets from the eight centres
were merged for analysis. The primary end-point was all-cause
mortality at a mean follow-up of 3.0 years.
Results 347 (3.2%) patients had previous CABG. Patients with previous CABG were older and had more associated comorbidities
than patients who have never had CABG. In patients with previous CABG, the infarct related artery (IRA) was split evenly
between a bypass graft and a native vessel. Procedural success
(defined as TIMI 3 flow at the end of procedure) was less likely in
patients with previous CABG than in patients who had never
undergone CABG (80.7 vs 88.2% respectively, p<0.001). Patients
with previous CABG had higher all-cause mortality (30.1% vs
16.7%, p<=0.0001) during the follow-up period (figure 1). After
multivariate adjustment this difference persisted (HR: 1.3, 95% CI
1.11 to 1.63, p=0.02). When stratifying prior CABG patients by
the type of IRA (figure 2); long term MACE were significant more
likely in patients who had bypass graft PCI than in patients that
had native vessel PCI, 35.7% versus 20.4% (p=0.03).
Conclusions Previous CABG patients with STEMI treated with
primary PCI have higher long-term adverse events. The long-term
outcome is also worse if the IRA is a bypass graft rather than a
native coronary artery.
https://heart.bmj.com/content/heartjnl/99/suppl_2/A30.full.pdf
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http://dx.doi.org/10.1136/heartjnl-2013-304019.41