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November 1, 2018Circulation Cardiovascular Interventions

Outcomes of Percutaneous Coronary Intervention in Non–ST-Segment–Elevation Myocardial Infarction Patients With or Without Prior Coronary Bypass

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Key result

Percutaneous revascularization in NSTEMI patients with prior CABG was associated with adjusted 30-day and 1-year mortality similar to patients without prior CABG, regardless of the target vessel.

Why the study?

Does PCI target (native vessel vs bypass graft) affect mortality in NSTEMI patients with prior CABG compared to those without prior CABG?

Population

205,039 patients with NSTEMI who underwent PCI between 2007 and 2014

Comparison

PCI to native coronary or PCI to a bypass graft vs PCI to native coronary

Design

Editorial

Follow-up

1 year

Authors

MAMohamad AlkhouliInterventional / Structural CardiologyVMVerghese MathewInterventional Cardiology

Discussion

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Implication

In NSTEMI patients with prior CABG, PCI to either native vessels or bypass grafts yields similar adjusted short- and mid-term outcomes compared to PCI in patients without prior CABG.

Structured PICO

Does PCI target (native vessel vs bypass graft) affect mortality in NSTEMI patients with prior CABG compared to those without prior CABG?

P
Population
205,039 NSTEMI patients who underwent PCI between 2007 and 2014 from a national database, analyzed to compare outcomes based on prior CABG status and revascularization target.
E
Exposure
PCI to native coronary (in patients with prior CABG) or PCI to a bypass graft
C
Comparator
PCI to native coronary (in patients with no prior CABG)
O
Outcome
30-day and 1-year mortalityhard clinical

In NSTEMI patients with prior CABG, PCI to either native vessels or bypass grafts yields similar adjusted short- and mid-term outcomes compared to PCI in patients without prior CABG.

Limitations

  • Registry only included NSTEMI patients who underwent PCI, excluding medically managed or redo-CABG patients
  • Reasons for referral or avoidance of PCI are unknown
  • Potential selection bias due to underrepresentation of prior CABG patients (9%)
  • Unmeasured confounding from lesion characteristics, graft age/degeneration, and operator experience
  • Assumption that NSTEMI was caused by previously bypassed vessel or graft
  • Requires longer-term follow-up than 1 year
  • Registry only included patients who underwent PCI, excluding medically managed or redo-CABG patients (selection bias)
  • Low proportion of prior CABG patients (9%) compared to US registries
  • Unmeasured confounders such as lesion characteristics, graft age, degree of degeneration, and operator experience
  • Assumption that NSTEMIs in prior CABG patients were caused by lesions in previously bypassed vessels or bypass grafts
  • Need for longer-term follow-up beyond 1 year

Cite This Study

Alkhouli et al. (2018) conducted an editorial in Non-ST-Segment-Elevation Myocardial Infarction (NSTEMI) (n=205,039). PCI in patients with prior CABG vs. PCI in patients without prior CABG was evaluated on 30-day and 1-year mortality. Percutaneous revascularization in NSTEMI patients with prior CABG was associated with adjusted 30-day and 1-year mortality similar to patients without prior CABG, regardless of the target vessel.

synapsesocial.com/papers/6a8465a0356b31aeb3f30619https://doi.org/10.1161/circinterventions.118.007460

Topics

STEMI managementPercutaneous coronary interventionChronic total occlusion PCI
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Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Outcomes of Patients With Acute Coronary Syndromes and Prior Coronary Artery Bypass Grafting2002 · 63 citations
  2. 2Non‐ST‐Elevation Myocardial Infarction in the United States: Contemporary Trends in Incidence, Utilization of the Early Invasive Strategy, and In‐Hospital Outcomes2014 · 106 citations
  3. 3Outcomes Following Percutaneous Coronary Intervention in Non–ST-Segment–Elevation Myocardial Infarction Patients With Coronary Artery Bypass Grafts2018 · 33 citations
  4. 42011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention2011 · 3,303 citations