Key result
Among 100 post-CABG patients presenting with ACS, the culprit vessel was a saphenous vein graft in 49%, and 47% were managed with percutaneous coronary intervention.
Why the study?
Patients presenting with ACS after CABG represent a distinct subset with multiple comorbidities, and symptom recurrence may arise from native vessel disease, graft disease, or both.
Observational (n=100)
No
Answers are grounded in this paper and cite their sources.
In patients presenting with ACS after prior CABG, saphenous vein grafts are the most common culprit vessels, and nearly half can be managed with percutaneous coronary intervention.
Objectives: Patients presenting as acute coronary syndromes (ACS) after coronary artery bypass graft (CABG) surgery are different subset with multiple comorbidities. Reappearance of symptoms could be due to either native vessel, graft disease, or both. The aim of the present study was to evaluate the mode of presentation, angiographic profile, and management strategies followed in them. Methods: One hundred consecutive patients presenting with ACS during 2 years' period at a tertiary care hospital were studied. ST segment elevation myocardial infarction (STEMI) was noted only in 7 cases, rest had either non-STEMI or unstable angina. Their comorbid risk factors, echocardiographic left ventricular ejection fraction were noted. All of them undergone invasive coronary angiography followed by revascularization as indicated. Results: Fifty percent of cases presented with reappearance of symptoms within 10 years after surgery. Culprit vessel identified was saphenous vein graft (SVG) in 49% followed by native vessel in (22%), both SVG and native vessel in 15%. Only 14% showed left internal mammary artery (LIMA) graft block at distal anastomotic site. Percutaneous coronary intervention was done in 47, redo CABG surgery in 8 cases. Rest were continued on optimal medical treatment. Of the 47 who have undergone PCI, 14 were done for SVGs and in 4 to LIMA graft to the left anterior descending. PCI to native vessel was done in 22 cases and in 7 one SVG and one native vessel. Conclusions: Post-CABG surgery patients are high risk subset with multiple comorbidities including impaired renal functions. Presentation as STEMI was less common. Majority of them can be managed with PCI of grafts or native vessels or both. Optimal medical treatment was advised in whom intervention or redo CABG is not feasible. More studies are needed comparing post-CABG ACS patients with de novo cases in Indian patients.
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Sathyamurthy et al. (2021) conducted an observational in Acute coronary syndromes after coronary artery bypass graft surgery (n=100). Angiographic profile and management strategies was evaluated on Culprit vessel identification and management strategy. Among 100 post-CABG patients presenting with ACS, the culprit vessel was a saphenous vein graft in 49%, and 47% were managed with percutaneous coronary intervention.
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