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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Outcomes Following Primary Percutaneous Coronary Intervention in Patients With Previous Coronary Artery Bypass
Javaid Iqbal1, Chun Shing Kwok1, Evangelos Kontopantelis1
1From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK (C.S.K., M.A.M.); Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands NHS Trust, UK (C.S.K., M.G., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); and Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (M.G., A.Z.).
Insights
Patients with prior coronary artery bypass grafting (CABG) undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) do not face increased mortality risk. Prior CABG is a marker for other high-risk features, not an independent risk factor.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Limited data exists on outcomes for ST-elevation myocardial infarction (STEMI) patients with prior coronary artery bypass grafting (CABG) undergoing primary percutaneous coronary intervention (PPCI).
- Real-world data on this specific patient population is scarce.
Purpose of the Study:
- To evaluate the outcomes of patients with STEMI undergoing PPCI, comparing those with and without a history of CABG.
- To determine if prior CABG independently impacts mortality and adverse events in STEMI patients treated with PPCI.
Main Methods:
- A large, real-world, all-comer dataset from England and Wales (2007-2012) was analyzed.
- Clinical, demographic, procedural, and outcomes data for STEMI patients undergoing PPCI were collected.
- All-cause mortality at 30 days and 1 year were assessed in the overall and propensity-matched cohorts.
Main Results:
- Of 79,295 STEMI patients, 2,658 (3.4%) had prior CABG, with PPCI performed on native vessels (44%) or bypass grafts (56%).
- Patients with prior CABG showed higher unadjusted 30-day mortality (6.2-6.1%) compared to those without (4.5%; P<0.001).
- After risk factor adjustment and in propensity-matched analysis, no significant difference in 30-day mortality or major adverse cardiovascular events was observed between groups.
Conclusions:
- A history of CABG in STEMI patients undergoing PPCI does not independently increase mortality risk.
- Prior CABG serves as an indicator of other underlying high-risk characteristics in these patients.
Background:
There are limited data on outcomes of patients with previous coronary artery bypass grafting (CABG) presenting with ST-segment-elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PPCI). We report outcomes in patients with STEMI undergoing PPCI with or without previous CABG surgery in a large real-world, all-comer population.
Methods And Results:
Clinical, demographic, procedural, and outcomes data were collected for all patients undergoing PPCI in England and Wales from January 2007 to December 2012. All-cause mortality at 30 days and 1 year were evaluated in the whole and a propensity-matched cohort. Of 79 295 patients with STEMI studied, 2658 (3.4%) patients had prior CABG, of whom 44% (n=1168) underwent PPCI to native vessels and 56% (n=1490) to bypass grafts. There were significant differences in the demographic, clinical, and procedural characteristics of these groups. Patients with prior CABG (with primary PCI to native artery or graft) had higher mortality at 30 days (6.2% with PPCI to native artery, 6.1% with PPCI to bypass graft) than patients with no prior CABG (4.5%; P<0.001). However, after risk factor adjustments, there was no significant difference in outcomes. There were also no significant differences in 30-day mortality, in-hospital major adverse cardiovascular events, in-hospital stroke, and in-hospital bleeding in the propensity-matched population.
Conclusions:
A prior history of CABG in patients presenting with STEMI and undergoing PPCI does not independently confer additional risk of mortality, although it is a marker of other high-risk features.
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