Clinical presentation of patients with prior coronary artery bypass grafting and suspected acute myocardial infarction
Key result
Prior CABG in patients with suspected AMI was associated with significantly lower diagnostic accuracy of integrated clinical judgement compared to no prior CABG (AUC 0.80 vs 0.87; P=0.004).
Why the study?
Diagnosis of acute myocardial infarction can be challenging in patients with prior coronary artery bypass grafting.
Does the diagnostic accuracy of chest pain characteristics and ECG for acute myocardial infarction differ in patients with prior CABG compared to those without?
Population
4015 patients presenting to the ED with suspected AMI (plus validation cohort n = 13 653)
Comparison
Prior CABG vs no prior CABG
Design
Prospective diagnostic cohort study with independent external validation
Authors
Discussion
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Implication
Lower diagnostic accuracy of clinical judgement after CABG warrants cautious AMI interpretation; this cohort study leaves open whether routine early angiography improves outcomes.
Study Design
Type
Cohort (n=4,015)
Structured PICO
Does the diagnostic accuracy of chest pain characteristics and ECG for acute myocardial infarction differ in patients with prior CABG compared to those without?
P
Population
4,015 patients presenting to the emergency department with suspected acute myocardial infarction, evaluated for diagnostic accuracy based on prior CABG status.
E
Exposure
Diagnostic assessment using 34 chest pain characteristics and 4 electrocardiogram signatures in patients with prior CABG.
C
Comparator
Diagnostic assessment in patients without prior CABG.
O
Outcome
Diagnostic accuracy of integrated clinical judgement for acute myocardial infarction, quantified by the area under the curve (AUC).surrogate
Main Result
Absolute Event Rate: 0.8% vs 0.87%
p-value: p=0.004
Patients with prior CABG presenting with suspected AMI have a higher prevalence of AMI and unstable angina but lower diagnostic accuracy from chest pain characteristics and ECG, supporting the liberal use of early coronary angiography.
Cite This Study
Koechlin et al. (2020) conducted a cohort in Suspected acute myocardial infarction (n=4,015). Prior coronary artery bypass grafting (CABG) vs. No prior CABG was evaluated on Diagnostic accuracy of integrated clinical judgement (Area Under the Curve) (p=0.004). Prior CABG in patients with suspected AMI was associated with significantly lower diagnostic accuracy of integrated clinical judgement compared to no prior CABG (AUC 0.80 vs 0.87; P=0.004).