Key result
In patients presenting with STEMI undergoing primary PCI, a history of previous CABG was not associated with a significant increase in long-term mortality compared to no prior CABG (HR 1.1, 95% CI 0.54-2.27, p=0.79).
Why the study?
Does a previous history of CABG affect mortality and angiographic outcomes in STEMI patients undergoing primary PCI?
Observational (n=2,133)
No
Does a previous history of CABG affect mortality and angiographic outcomes in STEMI patients undergoing primary PCI?
Hazard Ratio: 1.1 (95% CI 0.54–2.27)
Absolute Event Rate: 17% vs 10%
p-value: p=0.79
In STEMI patients undergoing primary PCI, a history of prior CABG is associated with worse acute angiographic reperfusion but does not significantly worsen short- or long-term mortality.
May signal more difficult reperfusion in post-CABG STEMI; leaves open tailored strategies pending prospective data.
BACKGROUND: There are limited data on outcomes of patients with previous coronary artery bypass grafting (CABG) presenting acutely as ST-segment elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PPCI). OBJECTIVES: To compare outcomes in STEMI patients undergoing PPCI with or without previous CABG surgery. METHODS: An all-comer single-centre observational registry from a cardiothoracic centre in UK. All consecutive patients presenting for PPCI between 2007 and 2012 were included. Electronic records were used to extract relevant information. Mortality data were obtained from the Office of National Statistics. Overall median follow-up period was 1.7 years (intraquartile range 0.9-2.5). RESULTS: Complete data were available for 2133 (97%) patients. 47-patients had previous history of CABG. Out of these, the infarct related artery (IRA) was native vessel in 22 and graft in 25 patients. Post re-vascularization TIMI flow was inferior in CABG cohort (<TIMI 3 flow in 17% vs. 10%, p=0.012) and they were less likely to achieve acute reperfusion (TIMI 0 in 9% vs. 3%, p=0012). In-hospital-mortality was not different in both groups (2%vs.4%, p=0.23). 30-day (HR 0.54; 95%CI 0.17-1.73; P=0.301), 1-year-mortality (HR 0.77; 95%CI 0.31-1.87; P=0.56) and over a median follow-up of 1.7 years (HR 1.1; 95%CI 0.54-2.27; P=0.79) were also not different. CONCLUSION: Patients presenting with STEMI to PPCI service with history of CABG are less likely to achieve acute reperfusion and have worse angiographic outcomes. Post PPCI, the prior CABG patients do not seem to have worse shortterm and long-term prognosis.
No takes yet. Share an insight, caveat, or question.
Garg et al. (2015) conducted an observational in ST-segment elevation myocardial infarction (n=2,133). Previous coronary artery bypass grafting vs. No previous coronary artery bypass grafting was evaluated on Long-term all-cause mortality (HR 1.1, 95% CI 0.54-2.27, p=0.79). In patients presenting with STEMI undergoing primary PCI, a history of previous CABG was not associated with a significant increase in long-term mortality compared to no prior CABG (HR 1.1, 95% CI 0.54-2.27, p=0.79).
Synapse has enriched 3 closely related papers on similar clinical questions. Consider them for comparative context: