Characteristics and Long-Term Outcomes of Patients With Prior Coronary Artery Bypass Grafting Undergoing Primary
Shahyar Michael Gharacholou1, Freddy Del-Carpio Munoz2, Arashk Motiei3
1Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida.
Insights
Patients with prior coronary artery bypass grafts (CABG) undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI) had similar long-term survival but higher risks of major adverse cardiac events (MACE) compared to STEMI patients without prior CABG.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Limited data exist on outcomes for ST-elevation myocardial infarction (STEMI) patients with prior coronary artery bypass grafts (CABG).
- Understanding long-term results in this population is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate the characteristics and long-term outcomes of STEMI patients with prior CABG undergoing primary percutaneous coronary intervention (PCI).
- To compare survival and major adverse cardiac events (MACE) between STEMI patients with and without prior CABG.
Main Methods:
- Retrospective analysis of 3,212 STEMI patients undergoing primary PCI from 2000-2014.
- Kaplan-Meier methods and propensity score matching were used for survival and MACE analysis.
- Cox proportional hazards models identified independent predictors of outcomes.
Main Results:
- Of 3,212 STEMI patients, 296 (9.2%) had prior CABG.
- At 10 years, adjusted survival was similar (44% in CABG STEMI vs. 55% in non-CABG STEMI).
- Survival free of MACE was significantly lower in CABG STEMI patients (37-46%) compared to controls (63%).
- Neither prior CABG nor infarct-related artery (native vs. graft) independently predicted death or MACE.
Conclusions:
- Long-term survival for STEMI patients with prior CABG undergoing primary PCI is comparable to those without prior CABG.
- However, STEMI patients with prior CABG face a significantly higher risk of MACE.
- No significant changes in death or MACE rates were observed over time in the CABG STEMI cohort.
Abstract:
Limited data are available on characteristics and long-term outcomes of patients with coronary artery bypass grafts (CABG) undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI). Between January 2000 to December 2014, we identified STEMI patients with prior CABG undergoing primary percutaneous coronary intervention from 3 sites. Kaplan-Meier methods to estimate survival and major adverse cardiac events (MACE) were employed and compared to a propensity matched cohort of non-CABG STEMI patients. Independent predictors of outcomes were analyzed with Cox modeling. Of the 3,212 STEMI patients identified, there were 296 (9.2%) CABG STEMI patients, having nearly similar frequencies of culprit graft (47.6%) versus culprit native (52.4%) as the infarct-related artery (IRA). At 10 years, the adjusted survival was 44% in CABG STEMI versus 55% in non-CABG STEMI (HR 1.26; 95%CI 0.86 to 1.87; p = 0.72). Survival free of MACE was lower for CABG STEMI (graft IRA, 37%; native IRA, 46%) as compared to non-CABG STEMI controls (63%) (p = 0.02). Neither CABG history nor IRA (native vs graft) was independently associated with death or MACE in multivariable analysis. Temporal trends showed no significant change in death or MACE rates of CABG STEMI patients over time. In conclusion, long term survival of CABG STEMI patients is not significantly different than matched STEMI patients without prior CABG; however, CABG STEMI patients were at significantly higher risk for MACE events.
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