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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Incidence and Characteristics of ST-Elevation Myocardial Infarction in Patients With Previous Coronary Artery Bypass
Ilgizar Hart1, Vivek Bhat2, Sayyad Kyazimzade1
1Department of Medicine, Medical University of South Carolina, Charleston, USA.
Insights
Patients with prior coronary artery bypass graft (CABG) undergoing treatment for ST-elevation myocardial infarction (STEMI) were older with more comorbidities. Outcomes after percutaneous coronary intervention (PCI) were similar to those without prior CABG.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- ST-elevation myocardial infarction (STEMI) in patients with prior coronary artery bypass graft (CABG) is complex and understudied.
- Characterizing these patients is crucial for optimizing treatment strategies.
Purpose of the Study:
- To analyze the clinical and angiographic characteristics of STEMI patients with prior CABG.
- To compare outcomes of STEMI patients with and without prior CABG.
Main Methods:
- Retrospective review of STEMI alert database from June 2009 to December 2022.
- Identification and analysis of patients with prior CABG, comparing them to those without.
- Assessment of in-hospital and one-year mortality, complications, and length of stay.
Main Results:
- 35 (4.2%) of 836 STEMI patients had prior CABG; they were older (mean age 67) with more comorbidities.
- Percutaneous coronary intervention (PCI) was performed in 88.6%, often due to acute graft occlusion (45.2%).
- Saphenous vein graft (SVG) was most commonly involved; in-hospital mortality was 5.7%, with similar one-year survival compared to non-CABG patients.
Conclusions:
- Patients with prior CABG represent a minority of STEMI cases but present with higher comorbidity burden.
- Clinical outcomes following PCI were comparable between prior CABG and non-CABG STEMI patients.
- Findings require cautious interpretation due to small sample size and observational design.
Introduction:
ST-elevation myocardial infarction (STEMI) in patients with prior coronary artery bypass graft (CABG) represents a complex entity, with limited characterization. We sought to analyze the clinical and angiographic characteristics of post-CABG patients presenting with STEMI at a single, large referral center in the Southeastern United States.
Methods:
We reviewed the STEMI alert database at the Medical University of South Carolina (MUSC). We included all patients with STEMI, as defined by the Fourth Universal Definition of Myocardial Infarction, who presented between June 2009 and December 2022. From this, we then identified those with prior CABG and analyzed their clinical and angiographic features. We compared these characteristics with patients without prior CABG. Finally, we analyzed outcomes including in-hospital complications, length of stay (LOS), in-hospital mortality, and one-year mortality.
Results:
Of 836 true STEMIs, 35 (4.2%) patients had a previous CABG. The mean (standard deviation (SD)) age was 67 (12) years, and most were male patients with multiple comorbidities. Thirty-one (88.6%) underwent percutaneous coronary intervention (PCI), of which 14 (45.2%) were due to acute graft occlusion. The most common graft involved was the saphenous vein graft (SVG), seen in 13 (41.9%), while multiple-vessel PCI was the most common in those with native vessel disease, seen in six (19.4%). Most patients achieved thrombolysis in myocardial infarction (TIMI) grade 3 revascularization. In-hospital mortality occurred in two (5.7%) patients, and the mean length of stay was five days. Compared to patients without prior CABG, they were older and had greater comorbidity burdens, but survival did not differ significantly.
Conclusion:
Patients with prior CABG constitute the minority of patients presenting with STEMI. Post-CABG patients were typically older and had a greater comorbidity burden than those without prior CABG. Clinical outcomes after PCI were similar between the two groups, although cautious interpretation is warranted, given the small sample and observational nature of our study.
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