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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Outcomes Following Percutaneous Coronary Intervention in Non-ST-Segment-Elevation Myocardial Infarction Patients With
Ahmad Shoaib1, Tim Kinnaird2, Nick Curzen3
1Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University (A.S., M.R., C.S.K., J.N., M.A.M.).
Insights
Patients with prior coronary artery bypass graft (CABG) surgery undergoing percutaneous coronary intervention (PCI) for non-ST-segment-elevation myocardial infarction have more comorbidities but no increased mortality risk after adjustment. Prior CABG does not independently increase adverse outcomes in these patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Outcomes Research
Background:
- Limited data exist on outcomes for patients with prior coronary artery bypass graft (CABG) undergoing percutaneous coronary intervention (PCI) for non-ST-segment-elevation myocardial infarction (NSTEMI).
- Comparing outcomes in NSTEMI patients undergoing PCI with or without prior CABG is crucial for clinical decision-making.
Purpose of the Study:
- To compare clinical characteristics and outcomes of NSTEMI patients undergoing PCI, stratified by prior CABG status.
- To determine if prior CABG independently impacts mortality and major adverse cardiovascular events (MACE) after PCI for NSTEMI.
Main Methods:
- Analysis of a national cohort of 205,039 NSTEMI patients undergoing PCI (2007-2014) from the British Cardiovascular Intervention Society database.
- Patients were divided into three groups: PCI in native arteries without prior CABG, PCI in native arteries with prior CABG, and PCI in grafts.
- Multivariable analysis was used to adjust for clinical differences and assess outcomes.
Main Results:
- Patients with prior CABG (groups 2 and 3) were older, had more comorbidities, and showed higher unadjusted 30-day and 1-year mortality compared to those without prior CABG (group 1).
- After multivariable adjustment, no significant differences were observed in 30-day mortality, in-hospital MACE, or in-hospital stroke between patients with and without prior CABG.
- Odds ratios for 30-day mortality were 0.87 (95% CI, 0.69-1.80) for PCI in native arteries with prior CABG and 0.91 (95% CI, 0.71-1.17) for PCI in grafts, compared to reference group 1.
Conclusions:
- While patients with prior CABG undergoing PCI for NSTEMI present with more comorbidities, prior CABG itself does not independently increase the risk of mortality or major adverse cardiovascular events.
- These findings suggest that PCI is a safe and effective revascularization strategy for NSTEMI patients with prior CABG, after accounting for baseline differences.
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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