Outcomes following primary percutaneous coronary intervention in patients with previous coronary artery bypass surgery

Abstract

Background: There are limited data on outcomes of patients with previous coronary artery bypass grafting (CABG) presenting with ST-segment elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PPCI). We report outcomes in STEMI patients undergoing PPCI with or without previous CABG surgery in a large real-world, all-comer population. Methods and Results: Clinical, demographic, procedural and outcomes data were collected for all patients undergoing PPCI in England and Wales from January 2007 to December 2012. All-cause mortality at 30-days and 1-year were evaluated in the whole and a propensity-matched cohort. Of 79,295 STEMI patients studied, 2,658 (3.4%) patients had prior CABG, of whom 44% (n=1,168) underwent PPCI to native vessels and 56% (n=1,490) to bypass grafts. There were significant differences in the demographic, clinical and procedural characteristics of these groups. Patients with prior CABG (with primary PCI to native artery or graft) had higher mortality at 30-days (6.2% with PPCI to native artery, 6.1% with PPCI to bypass graft) than patients with no prior CABG (4.5%, p<0.001). However after risk factor adjustments there was no significant difference in outcomes. There were also no significant differences in 30-day mortality, in-hospital MACE, in-hospital stroke and in-hospital bleeding in the propensity-matched population. Conclusion: A prior history of CABG in patients presenting with STEMI and undergoing PPCI does not independently confer additional risk of mortality, although it is a marker of other high-risk features.