Key result
Prior CABG is linked to ~29% more major events in acute MI patients with HF.
Why the study?
Does prior CABG worsen clinical outcomes in patients presenting with acute myocardial infarction complicated by heart failure or left ventricular systolic dysfunction?
Cohort (n=14,703)
Does prior CABG worsen clinical outcomes in patients presenting with acute myocardial infarction complicated by heart failure or left ventricular systolic dysfunction?
Patients with prior CABG presenting with acute myocardial infarction and heart failure or LV dysfunction have a significantly higher risk of adverse cardiovascular outcomes compared to those without prior CABG.
Prior CABG marks higher-risk post-MI patients (adj. HR 1.29); leaves open whether intensified secondary prevention improves prognosis.
AIMS: The number of patients presenting with an acute myocardial infarction (MI) and prior coronary artery bypass grafting (CABG) is increasing. We compared the baseline characteristics, treatment, and clinical outcomes of patients with and without prior CABG in the VALIANT trial. METHODS AND RESULTS: Of the 14 703 patients with heart failure (HF), left ventricular systolic dysfunction, or both enrolled in VALIANT, 1026 (7%) had prior CABG. Prior CABG patients were older [mean age (SD): 67 (10) vs. 65 (12) years; P < 0.0001], had more comorbidity, and more frequent non-Q wave MI (66 vs. 30%; P < 0.0001). At hospital presentation, prior CABG patients received less aspirin (82 vs. 90%; P < 0.0001) and thrombolysis (21 vs. 36%; P < 0.0001), but had a similar rate of primary percutaneous coronary intervention (14 vs. 15%; P = 0.2). Prior CABG patients were more likely to experience the composite outcome of cardiovascular death, MI, HF, resuscitated cardiac arrest, or stroke; 3 year Kaplan-Meier rate, 64 vs. 39% (adjusted hazard ratio 1.29, 95% confidence interval 1.17-1.43; P < 0.0001). CONCLUSION: Patients with prior CABG had a worse clinical profile and experienced more fatal and non-fatal outcomes. Greater recognition is necessary for these high-risk patients including optimization of evidence-based secondary preventive therapy.
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Berry et al. (2009) conducted a cohort in Acute myocardial infarction with heart failure and/or left ventricular systolic dysfunction (n=14,703). Prior coronary artery bypass grafting (CABG) vs. No prior CABG was evaluated on Composite outcome of cardiovascular death, MI, HF, resuscitated cardiac arrest, or stroke (HR 1.29, 95% CI 1.17-1.43, p=< 0.0001). Prior CABG in acute MI patients with heart failure increased the 3-year risk of cardiovascular death, MI, HF, arrest, or stroke (64% vs 39%; HR 1.29, 95% CI 1.17-1.43; P<0.0001).
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