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Outcome after acute myocardial infarction in patients with prior coronary artery bypass surgery
H C Dittrich1, E Gilpin, P Nicod
1Division of Cardiology, University of California San Diego Medical Center 92103.
Insights
Patients with prior coronary artery bypass grafting (CABG) undergoing treatment for acute myocardial infarction (AMI) showed increased complications and poorer heart function post-discharge, though in-hospital mortality was similar. This highlights the need for closer monitoring in these high-risk cardiac patients.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- The impact of prior coronary artery bypass grafting (CABG) on acute myocardial infarction (AMI) outcomes is not well-established.
- Understanding these outcomes is crucial for managing patients with a history of revascularization presenting with AMI.
Purpose of the Study:
- To evaluate the influence of remote prior coronary artery bypass grafting (CABG) on the clinical outcomes of patients experiencing acute myocardial infarction (AMI).
Main Methods:
- Retrospective analysis of 2,494 patients with AMI, comparing outcomes between 219 patients with prior CABG and the rest.
- Data collected included patient demographics, comorbidities, in-hospital events, and post-discharge monitoring (electrocardiography, ejection fraction, coronary angiography).
Main Results:
- Patients with prior CABG had higher rates of prior AMI, congestive heart failure, angina, recurrent ischemic pain, and non-Q-wave AMI during hospitalization.
- Post-discharge, they exhibited more complex ventricular ectopic activity and lower ejection fraction.
- Multivessel coronary artery disease was also more prevalent in the prior CABG group.
Conclusions:
- Prior CABG is associated with a higher burden of cardiovascular disease and increased complications in patients with AMI.
- Despite similar in-hospital mortality, patients with prior CABG have worse cardiac function and higher prevalence of complex coronary disease post-AMI.
- These findings suggest a need for intensified management and monitoring for patients with prior CABG who experience AMI.
Abstract:
Little is known concerning the influence of remote prior coronary artery bypass grafting (CABG) on the outcome of patients with acute myocardial infarction (AMI). Therefore, this study evaluated 2,494 patients with AMI of whom 219 (8.8%) had a history of CABG a mean of 7.1 +/- 3.7 years before the index AMI. Compared with all other patients, those with a history of CABG had an increased prevalence of a history of prior AMI (153 [70%] vs 547 [24%]), congestive heart failure (48 [22%] vs 236 [10%]), and angina pectoris (165 [75%] vs 787 [35%]), all p < 0.001. There was no difference in age, but patients with prior CABG were more often men (192 [88%] vs 1,702 [75%], p < 0.001). During the hospitalization for AMI, patients with prior CABG had more recurrent ischemic pain (100 [46%] vs 732 [32%, p < 0.001]), and more frequently developed non-Q-wave AMI (72 [33%] vs 514 [23%], p < 0.01). In-hospital mortality did not differ among patients with or without prior CABG (15 [7%] vs 195 [9%]). At hospital discharge, more patients with prior CABG had complex ventricular ectopic activity on 24-hour ambulatory electrocardiographic monitoring (48 of 74 [65%] vs 327 of 797 [41%], p < 0.0001), and radionuclide ejection fraction < 0.45 (53 of 99 [54%] vs 430 of 1,024 [42%], p < 0.01). Among patients undergoing coronary angiography during the first 2 months, multivessel coronary artery disease was more prevalent among patients with prior CABG (78 of 107 [73%] vs 508 of 959 [53%], p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)