Comparison of Outcomes of Patients with vs without Previous Coronary Artery Bypass Graft Surgery Presenting with

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Judit Karacsonyi1, Christian W Schmidt1, Brynn K Okeson1

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

The American Journal of Cardiology
|July 10, 2021
PubMed

Insights

Patients with prior coronary artery bypass graft (CABG) surgery experiencing ST-segment elevation myocardial infarction (STEMI) face worse long-term outcomes, including higher mortality and major adverse cardiac events, even after accounting for other risk factors.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Outcomes Research

Background:

  • Outcomes for ST-segment elevation acute myocardial infarction (STEMI) patients with prior coronary artery bypass graft (CABG) surgery are not well-established.
  • Limited research exists on the specific clinical and procedural characteristics of STEMI patients with a history of CABG.

Purpose of the Study:

  • To compare the clinical characteristics, procedural aspects, and long-term outcomes of STEMI patients with and without previous CABG.
  • To identify if previous CABG is an independent predictor of mortality and major adverse cardiac events (MACE) after STEMI.

Main Methods:

  • Analysis of a contemporary multicenter STEMI registry (2003-2020).
  • Inclusion of 13,893 STEMI patients, with 7.2% having prior CABG.
  • Kaplan-Meier survival analysis and log-rank tests to compare outcomes; multivariable adjustment for baseline characteristics.

Main Results:

  • Previous CABG patients were older, more frequently male, and had higher rates of diabetes.
  • Patients with prior CABG experienced significantly higher 5-year mortality and MACE (death, myocardial infarction, stroke) compared to those without.
  • Prior CABG was independently associated with increased mortality from discharge to 18 months and 18 months to 5 years post-STEMI.

Conclusions:

  • Long-term outcomes following STEMI are poorer in patients with a history of CABG.
  • Previous CABG is a significant independent predictor of adverse outcomes after STEMI, underscoring the need for tailored management strategies.

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