Outcomes following percutaneous coronary intervention in non-ST-segment-elevation myocardial infarction patients with coronary artery bypass grafts

Shoaib, Ahmad, Kinnaird, Tim, Curzen, Nick, Kontopantelis, Evangelos, Ludman, Peter, de Belder, Mark, Rashid, Muhammad, Kwok, Chun Shing, Nolan, James, Zaman, Azfar and Mamas, Mamas A. (2018) Outcomes following percutaneous coronary intervention in non-ST-segment-elevation myocardial infarction patients with coronary artery bypass grafts. Circulation. Cardiovascular interventions, 11 (11), e006824. (doi:10.1161/CIRCINTERVENTIONS.118.006824).

Abstract

Background: There are limited data on outcomes of patients with previous coronary artery bypass graft (CABG) presenting with non-ST-segment-elevation myocardial infarction undergoing percutaneous coronary intervention (PCI). We compare clinical characteristics and outcomes in non-ST-segment-elevation myocardial infarction patients undergoing PCI with or without prior CABG surgery in a national cohort.

 Methods and Results: We identified 205 039 patients with non-ST-segment-elevation myocardial infarction who underwent PCI between 2007 and 2014 in the British Cardiovascular Intervention Society database. Clinical, demographic, procedural, and outcome data were analyzed by dividing into 3 groups: group 1, PCI in native coronary arteries and no prior CABG (n=186 670); group 2, PCI in native arteries with prior CABG (n=8825); group 3, PCI in grafts (n=9544). Patients in group 2 and 3 were older and had more comorbidities and higher mortality at 30 days (group 2, 2.6% and group 3, 1.9%) and 1 year (group 2, 8.29% and group 3, 7.08%) as compared with group 1 (1.7% and 4.87%). After multivariable analysis, no significant difference in outcomes was observed in 30-days mortality (odds ratio; group 2=0.87 [CI, 0.69-1.80; P=0.20], group 3=0.91 [CI, 0.71-1.17; P=0.46]), in-hospital major adverse cardiovascular event (odds ratio: group 2=1.08 [CI, 0.88-1.34; P=0.45], group 3=0.97 [CI=0.77-1.23; P=0.82]), and in-hospital stroke (odds ratio: group 2=1.37 [CI, 0.71-2.69; P=0.35], group 3=1.13 [CI, 0.55-2.34; P=0.73]; group 1=reference). 

Conclusions: Patients with prior CABG are presenting with non-ST-segment-elevation myocardial infarction and treated with PCI had more comorbid illnesses, but once these differences were adjusted for, prior CABG did not independently confer additional risk of mortality and major adverse cardiovascular event.

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Contributors

Author: Nick Curzen

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