Outcomes of Primary Percutaneous Coronary Intervention for Patients with Previous Coronary Artery Bypass Grafting Presenting with STsegment Elevation Myocardial Infarction



Pankaj Garg1, *, Hazlyna Kamaruddin1, Javaid Iqbal1, 2, Nigel Wheeldon1
1 Department of Cardiology and Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road S5 7AU, UK
2 Department of Cardiovascular Science, University of Sheffield, Medical School, Beech Hill Road, S10 2RX, UK


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© Garg et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/bync/ 4.0/), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield S5 7AU, United Kingdom, Tel: +441142714950; Fax: +44114 2610350; Email: pankajvic@gmail.com


Abstract

Background:

There are limited data on outcomes of patients with previous coronary artery bypass grafting (CABG) presenting acutely as ST-segment elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PPCI).

Objectives:

To compare outcomes in STEMI patients undergoing PPCI with or without previous CABG surgery.

Methods:

An all-comer single-centre observational registry from a cardiothoracic centre in UK. All consecutive patients presenting for PPCI between 2007 and 2012 were included. Electronic records were used to extract relevant information. Mortality data were obtained from the Office of National Statistics. Overall median follow-up period was 1.7 years (intraquartile range 0.9-2.5).

Results:

Complete data were available for 2133 (97%) patients. 47-patients had previous history of CABG. Out of these, the infarct related artery (IRA) was native vessel in 22 and graft in 25 patients. Post re-vascularization TIMI flow was inferior in CABG cohort (<TIMI 3 flow in 17% vs. 10%, p=0.012) and they were less likely to achieve acute reperfusion (TIMI 0 in 9% vs. 3%, p=0012). In-hospital-mortality was not different in both groups (2%vs.4%, p=0.23). 30-day (HR 0.54; 95%CI 0.17-1.73; P=0.301), 1-year-mortality (HR 0.77; 95%CI 0.31-1.87; P=0.56) and over a median follow-up of 1.7 years (HR 1.1; 95%CI 0.54-2.27; P=0.79) were also not different.

Conclusion:

Patients presenting with STEMI to PPCI service with history of CABG are less likely to achieve acute reperfusion and have worse angiographic outcomes. Post PPCI, the prior CABG patients do not seem to have worse shortterm and long-term prognosis.

Keywords: Acute myocardial infarction/STEMI, coronary bypass grafts, Primary PCI.