Shoaib, A ORCID: https://orcid.org/0000-0003-0513-8319, Mohamed, M ORCID: https://orcid.org/0000-0002-9678-5222, Rashid, M ORCID: https://orcid.org/0000-0001-9725-1583, Khan, SU, Parwani, P, Contractor, T, Shaikh, H, Ahmed, W, Fahy, E, Prior, J, Fischman, D, Bagur, R ORCID: https://orcid.org/0000-0003-1888-9429 and Mamas, MA ORCID: https://orcid.org/0000-0001-9241-8890 (2021) Clinical Characteristics, Management Strategies and Outcomes of Acute Myocardial Infarction Patients With Prior Coronary Artery Bypass Grafting. Mayo Clinic Proceedings, 96 (1). 120 - 131.

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Abstract

OBJECTIVE: To investigate the management strategies, temporal trends, and clinical outcomes of patients with a history of coronary artery bypass graft (CABG) surgery and presenting with acute myocardial infarction (MI). PATIENTS AND METHODS: We undertook a retrospective cohort study using the National Inpatient Sample database from the United States (January 2004-September 2015), identified all inpatient MI admissions (7,250,768 records) and stratified according to history of CABG (group 1, CABG-naive [94%]; group 2, prior CABG [6%]). RESULTS: Patients in group 2 were older, less likely to be female, had more comorbidities, and were more likely to present with non-ST-elevation myocardial infarction compared with group 1. More patients underwent coronary angiography (68% vs 48%) and percutaneous coronary intervention (PCI) (44% vs 26%) in group 1 compared with group 2. Following multivariable logistic regression analyses, the adjusted odd ratio (OR) of in-hospital major adverse cardiovascular and cerebrovascular events (OR, 0.98; 95% CI, 0.95 to 1.005; P=.11), all-cause mortality (OR, 1; 95% CI, 0.98 to 1.04; P=.6) and major bleeding (OR, 0.99; 95% CI, 0.94 to 1.03; P=.54) were similar to group 1. Lower adjusted odds of in-hospital major adverse cardiovascular and cerebrovascular events (OR, 0.64; 95% CI, 0.57 to 0.72; P<.001), all-cause mortality (OR, 0.45; 95% CI, 0.38 to 0.53; P<.001), and acute ischemic stroke (OR, 0.71; 95% CI, 0.59 to 0.86; P<.001) were observed in group 2 patients who underwent PCI compared with those managed medically without any increased risk of major bleeding (OR, 1.08; 95% CI, 0.94 to 1.23; P=.26). CONCLUSIONS: In this national cohort, MI patients with prior-CABG had a higher risk profile, but similar in-hospital adverse outcomes compared with CABG-naive patients. Prior-CABG patients who received PCI had better in-hospital clinical outcomes compared to those who received medical management.

Item Type: Article
Additional Information: The final version of this article and all relevant information can be found online at; https://www.sciencedirect.com/science/article/pii/S002561962030834X?via%3Dihub
Uncontrolled Keywords: Age Factors (D000367), Aged (D000368), Aged, 80 and over (D000369), Coronary Artery Bypass (D001026), Female (D005260), Humans (D006801), Logistic Models (D016015), Male (D008297), Middle Aged (D008875), Myocardial Infarction (D009203), Retrospective Studies (D012189), Risk Factors (D012307), Sex Factors (D012737)
Subjects: R Medicine > R Medicine (General)
R Medicine > RD Surgery
R Medicine > RD Surgery > RD32 Operative surgery. Technique of surgical operations
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Related URLs:
Depositing User: Symplectic
Date Deposited: 03 Feb 2021 14:20
Last Modified: 24 Feb 2021 16:09
URI: https://eprints.keele.ac.uk/id/eprint/9123

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