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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Outcome of patients with prior coronary bypass surgery admitted with an acute coronary syndrome
Ilan Marcuschamer1,2, Oren Zusman1,2, Z Iakobishvili1,2
1Cardiology Department, Rabin Medical Center, Petah Tikva, Israel.
Insights
Patients with prior coronary artery bypass graft surgery (CABG) admitted with acute coronary syndrome (ACS) saw improved treatments but unchanged 1-year mortality. Advances in ACS care did not improve long-term survival for these high-risk patients.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Patients with prior coronary artery bypass graft surgery (CABG) face higher risks of recurrent cardiovascular ischemic events.
- While acute coronary syndrome (ACS) management has advanced, its impact on patients with prior CABG remains unclear.
Purpose of the Study:
- To investigate temporal trends in the characteristics, treatment, and clinical outcomes of patients hospitalized with ACS who have a history of CABG.
Main Methods:
- A time-dependent analysis was conducted on ACS patients with or without prior CABG from 2000-2016.
- Outcomes assessed included 30-day major adverse cardiac events (MACE) and 1-year mortality.
- Patients were categorized into early (2000-2008) and late (2010-2016) periods.
Main Results:
- Among 15,152 ACS patients, 9.9% had prior CABG; these patients were older and had more comorbidities.
- Treatment with antiplatelets, statins, and percutaneous interventions increased significantly in both groups.
- While 30-day MACE decreased for both groups, 1-year mortality improved only for those without prior CABG, remaining unchanged for patients with prior CABG.
Conclusions:
- Despite improved ACS management over the past decade, 1-year mortality for patients with prior CABG admitted for ACS has not changed.
- This highlights a persistent gap in achieving long-term survival benefits for this specific patient population.
Background:
Patients with prior coronary artery bypass graft surgery (CABG) are at increased risk for recurrent cardiovascular ischaemic events. Advances in management have improved prognosis of patients with acute coronary syndrome (ACS), yet it is not known whether similar trends exist in patients with prior CABG.
Aim:
Examine temporal trends in the prevalence, treatment and clinical outcomes of patients with prior CABG admitted with ACS.
Methods:
Time-dependent analysis of patients with or without prior CABG admitted with an ACS who enrolled in the ACS Israeli Surveys between 2000 and 2016. Surveys were divided into early (2000-2008) and late (2010-2016) time periods. Outcomes included 30 days major adverse cardiac events (30d MACE) (death, myocardial infarction, stroke, unstable angina, stent thrombosis, urgent revascularisation) and 1-year mortality.
Results:
Among 15 152 patients with ACS, 1506 (9.9%) had a prior CABG. Patients with prior CABG were older (69 vs 63 years), had more comorbidities and presented more with non-ST elevation-ACS (82% vs 51%). Between time periods, utilisation of antiplatelets, statins and percutaneous interventions significantly increased in both groups (p<0.001 for each). The rate of 30d MACE decreased in patients with (19.1%-12.4%, p=0.001) and without (17.4%-9.5%, p<0.001) prior CABG. However, 1-year mortality decreased only in patients without prior CABG (10.5% vs 7.4%, p<0.001) and remained unchanged in patients with prior CABG. Results were consistent after propensity matching.
Conclusions:
Despite an improvement in the management and prognosis of patients with ACS in the last decade, the rate of 1-year mortality of patients with prior CABG admitted with an ACS remained unchanged.
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