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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
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Outcomes of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction patients with

Louis P Kohl1, Ross F Garberich1, Hannah Yang1

  • 1Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.

JACC. Cardiovascular Interventions
|September 20, 2014
PubMed

Insights

Patients with ST-segment elevation myocardial infarction (STEMI) and prior coronary artery bypass graft (CABG) surgery had similar short-term survival but higher 5-year mortality. Outcomes in the primary percutaneous coronary intervention era are improved compared to historical data.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Public Health

Background:

  • Outcomes for ST-elevation myocardial infarction (STEMI) patients with prior coronary artery bypass graft (CABG) surgery are historically worse than for those without prior CABG.
  • Limited contemporary data exists for STEMI patients with prior CABG, especially within the primary percutaneous coronary intervention (PCI) era.

Purpose of the Study:

  • To evaluate the current clinical characteristics and outcomes of STEMI patients with previous CABG.
  • To specifically assess outcomes related to saphenous vein graft (SVG) culprit lesions in this patient population.

Main Methods:

  • Data was collected from a large, regional STEMI system's prospective database.
  • Included 3,542 STEMI episodes between March 4, 2003, and April 22, 2012.
  • Compared outcomes between patients with and without prior CABG, and analyzed culprit lesion location.

Main Results:

  • 249 patients (7%) had prior CABG. Despite higher comorbidities, in-hospital and 1-year mortality were similar between groups.
  • Five-year mortality was significantly higher in patients with prior CABG (24.9% vs. 14.2%).
  • Saphenous vein graft (SVG) was the culprit lesion in 34% of CABG patients; left internal mammary artery (LIMA) grafts were not culprits. Thirty-day and 1-year mortality were not significantly different based on culprit lesion type.

Conclusions:

  • STEMI patients with prior CABG treated in a contemporary regional system show similar short-term outcomes to those without prior CABG, but with increased 5-year mortality.
  • Native vessels were the most frequent culprit lesions (42%) in STEMI patients with prior CABG.
  • Outcomes for STEMI patients with prior CABG have improved compared to historical reports.
Abstract

Keywords:
ST-segment elevation myocardial infarctioncoronary artery bypass graftoutcomespercutaneous coronary interventionregional care systems

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