Characteristics and Long-Term Outcomes of Patients With Prior Coronary Artery Bypass Grafting Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

Predictors of MACE following PPCI in patients with a prior history of CABG

BACKGROUND

Evidence suggests patients undergoing Primary Percutaneous Coronary Intervention (PPCI) who have a prior history of Coronary Artery Bypass Grafting (CABG) are more likely to experience adverse cardiac events compared to patients without prior CABG. We aimed to study risk factors of one-year Major Adverse Cardiovascular Events (MACE) in patients undergoing PPCI with a prior history of CABG.

METHODS

Patients with a history of CABG undergoing PPCI on Saphenous Vein Graft (SVG) were contacted one year after PPCI. One-year follow-up sought MACE, death, and cardiovascular hospitalisation.

RESULTS

A total of 69 patients were included in this study of which 66 were followed-up. Within the one-year follow-up, 6 (8.7%) patients were hospitalised due to cardiovascular causes, and 20 (29%) developed MACE. Patients with prior PCI had a significantly higher one-year MACE rate compared to others. Among patients undergoing pre-dilation, patients who experienced MACE had a significantly higher pre-dilation diameter. Moreover, patients experiencing MACE had a significantly lower Ejection Fraction (EF). According to logistic regression models, prior PCI, pre-dilation, and EF were predictors of one-year MACE. Furthermore, The EF was an independent predictor of one-year MACE.

CONCLUSION

Higher pre-dilation diameter might be associated with a higher one-year MACE rate in patients undergoing PPCI on SVG with a prior history of CABG. Additionally, EF was an independent predictor of one-year MACE.

Nomograms Based on Non-High-Density Lipoprotein to Predict Outcomes in Patients with Prior Coronary Artery Bypass Grafting with Acute Coronary Syndrome: A Single-Center Retrospective Study

Introduction

Non-high-density-lipoprotein cholesterol (non-HDL-C) is a secondary therapeutic target in cardiovascular diseases and is used for residual risk assessment in patients with coronary artery syndrome (ACS). This study was designed to determine the association between non-HDL-C in patients with prior coronary artery bypass graft (CABG) with ACS and clinical outcomes.

Methods

We retrospectively analyzed 468 patients with prior CABG with ACS and categorized them into two groups based on the median non-HDL-C level. The primary endpoints were major adverse cardiovascular events (MACEs), including cardiovascular death and recurrent myocardial infarction. Kaplan-Meier curves, Cox proportional-hazard regressions, and restricted cubic splines were used to determine the association between non-HDL-C and MACEs. The discrimination and reclassification of the nomogram based on non-HDL-C were assessed using time-dependent receiver operating characteristic (ROC) curves and net reclassification improvement (NRI).

Results

During the average follow-up time of 744.5 days, non-HDL-C was independently associated with the occurrence of MACEs (hazard ratio [HR] = 5.01, 95% confidence interval [CI] = 1.65-15.24; p = 0.005) after adjusting for other lipid parameters. The spline curves indicated a linear relationship between non-HDL-C and MACEs (p-nonlinear: 0.863). The time-dependent areas under the ROC curves of prior-CABG-ACS nomograms containing non-HDL regarding MACEs in two consecutive years were 91.7 (95% CI: 85.5-97.9) and 91.5 (95% CI: 87.3-95.7), respectively. The NRI analysis indicated that the prior-CABG-ACS model improved the reclassification ability for 1- and 2-year MACEs (22.4% and 7%, p < 0.05, respectively).

Discussion

Non-HDL is independently associated with the risk of MACEs in patients with prior CABG with ACS. The prior-CABG-ACS nomogram based on non-HDL-C and five convenient variables generates valid and stable predictions of MACE occurrence.

Cardiac catheterizations in patients with acute coronary syndrome and prior coronary bypass surgery: Impact of native vs graft vs absent culprit lesions on clinical outcomes and treatment strategy

BACKGROUND

In patients with prior coronary artery bypass graft surgery (CABG), acute coronary syndrome (ACS) is not uncommon. This study investigated treatment strategy and compared clinical outcomes for native, graft and absent culprit lesions.

METHODS

Single-center retrospective cohort study. From July 2010 to July 2019, 642 consecutive ACS patients with prior CABG were screened for eligibility. The primary endpoint was major adverse cardiovascular events (MACE) at 1 year, a composite of all-cause mortality, myocardial infarction, stroke and ischemia-driven revascularization.

RESULTS

A total of 549 patients were included, with 215 (39.2 %) having native culprits, 256 (46.6 %) graft culprits and 78 (14.2 %) no clear culprits. Patients with native culprits were treated with native PCI in 94.0 %, re-CABG in 0.9 % and optimal medical therapy (OMT) in 5.1 %. Patients with graft culprits were treated with native PCI in 14.1 %, graft PCI in 81.2 %, re-CABG in 0.8 % and OMT in 3.9 %. All patients without a clear culprit received OMT. The cumulative incidence of 1-year MACE was 24.7 % for native vs 26.2 % for graft vs 21.8 % for absent culprits. Kaplan-Meier curves did not differ significantly. In patients with graft culprit, no significant difference in 1-year MACE was observed between native PCI and graft PCI (30.6 % vs 25.5 %, p = 0.36).

CONCLUSIONS

This retrospective study shows that in ACS patients with prior CABG, MACE occured frequently and was comparable for native, graft and absent culprits. Native PCI as treatment strategy for patients with a graft culprit was relatively common, with no significant difference in MACE as compared to graft PCI.

Comparison of Outcomes of Patients with vs without Previous Coronary Artery Bypass Graft Surgery Presenting with ST-Segment Elevation Acute Myocardial Infarction

The outcomes of patients with previous coronary bypass graft surgery (CABG) presenting with ST-segment elevation acute myocardial infarction (STEMI) have received limited study. We compared the clinical and procedural characteristics and outcomes of STEMI patients with and without previous CABG in a contemporary multicenter STEMI registry between 2003 and 2020. The primary outcomes of the study were mortality and major cardiac adverse events (MACE: death, MI or stroke). Survival curves were derived using the Kaplan-Meier method and compared with the log-rank test. Of the 13,893 patients included in the analyses, 7.2% had previous CABG. Mean age was 62.4 ± 13.6 years, most patients (71%) were men and 22% had diabetes. Previous CABG patients were older (69.0 ± 11.7 vs 61.9 ± 13.6 years, p <0.001) and more likely to have diabetes (40% vs 21%, p <0.001) compared with patients without previous CABG. Previous CABG patients had higher mortality and MACE at 5 years (p <0.001). Outcomes were similar with saphenous vein graft vs native coronary culprits. Previous CABG remained associated with mortality from discharge to 18 months (p = 0.044) and from 18 months to 5 years (p <0.001) after adjusting for baseline characteristics. Long term outcomes after STEMI were worse among patients with previous CABG compared with patients without previous CABG, even after adjustment for baseline characteristics.