Outcomes of Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction Patients With Previous Coronary Bypass Surgery.

JACC. Cardiovascular interventions

PubMedID: 25234670

Kohl LP, Garberich RF, Yang H, Sharkey SW, Burke MN, Lips DL, Hildebrandt DA, Larson DM, Henry TD. Outcomes of Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction Patients With Previous Coronary Bypass Surgery. JACC Cardiovasc Interv. 2014;7(9):981-7.
OBJECTIVES
This study sought to determine the contemporary clinical characteristics and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) and previous coronary artery bypass graft (CABG), including those with a saphenous vein graft culprit lesion.

BACKGROUND
The outcome of STEMI patients with previous CABG is reported to be inferior to those without previous CABG, but limited data is available from the primary percutaneous coronary intervention era.

METHODS
Data was extracted from a large, regional STEMI system's prospective database, which contained 3,542 unique STEMI episodes from March 4, 2003 through April 22, 2012.

RESULTS
Previous CABG was present in 249 patients (7%). Despite higher comorbidity, patients with versus those without previous CABG had similar in-hospital (4.8% vs. 5.2%; p = 0.82) and 1-year (10.8% vs. 9.1%; p = 0.36) mortality, but 5-year (24.9% vs. 14.2%; p < 0.001) mortality was higher. Patients with previous CABG have similar door-to-balloon times. The culprit vessel was the saphenous vein graft in 84 patients (34%), a native vessel in 104 (42%), with no clear culprit in 59 (24%). The left internal mammary artery graft was not a culprit in any patient. Mortality at 30 days (8.3% vs. 3.9% vs. 1.7%, p = 0.19) and 1 year (14.3% vs. 9.0% vs. 6.8%; p = 0.35) was higher (but not statistically) with a saphenous vein graft culprit and was equivalent at 5 years (25.0% vs. 26.0% vs. 20.3%; p = 0.71).

CONCLUSIONS
Patients with previous CABG treated in a regional STEMI system have similar outcomes as patients without previous CABG, although 5-year mortality is higher. The most common culprit location was a native vessel (42%). Outcomes have improved significantly compared with historical reports.