Outcomes Following Percutaneous Coronary Intervention (PCI) in Non-ST-segment Elevation Myocardial Infarction Patients with Coronary Artery Bypass Grafts

Shoaib, Ahmad; Kinnaird, Tim; Curzen, Nick; Kontopantelis, Evangelos; Ludman, Peter; de Belder, Mark; Rashid, Muhammad; Shing Kwok, Chun; Nolan, James; Zaman, Azfar; Mamas, Mamas

Abstract

Background: There are limited data on outcomes of patients with previous CABG presenting with NSTEMI undergoing PCI. We compare clinical characteristics and outcomes in NSTEMI patients undergoing PCI with or without prior CABG surgery in a national cohort. Methods & Results: We identified 205,039 patients with NSTEMI who underwent PCI between 2007-2014 in the British Cardiovascular Intervention Society (BCIS) database. Clinical, demographical, procedural and outcome data were analysed by dividing into three groups; Group 1- PCI in native coronary arteries and no prior CABG (n= 186,670), Group 2- PCI in native arteries with prior CABG (n= 8,825), Group 3- PCI in Grafts (n= 9,544). Patients in Group 2 & 3 were older, had more comorbidities and higher mortality at 30 days (group 2 -2.6%, group 3 – 1.9%) and 1 year (group 2 – 8.29%, group 3 – 7.08%) as compared to Group 1 (1.7% & 4.87%). Following multivariable analysis, no significant difference in outcomes were observed in 30 days mortality (OR: group 2 = 0.87 (CI 0.69-1.80, P-0.20), group 3 = 0.91 (CI 0.71-1.17, P-0.46)), in-hospital MACE (OR: group 2 = 1.08 (CI 0.88-1.34, P- 0.45), group 3 0.97 (CI 0.77-1.23, P- 0.82)) and in-hospital stroke (OR: group 2 = 1.37 (CI 0.71-2.69, P - 0.35), group 3 = 1.13 (CI 0.55-2.34, P- 0.73))(group 1= reference). Conclusion: Patients with prior CABG presenting with NSTEMI and treated with PCI had more co-morbid illnesses but once these differences were adjusted for, prior CABG did not independently confer additional risk of mortality and MACE. Keywords: PCI, NSTEMI, Mortality, Complications

Citation

Shoaib, A., Kinnaird, T., Curzen, N., Kontopantelis, E., Ludman, P., de Belder, M., …Mamas, M. (2018). Outcomes Following Percutaneous Coronary Intervention (PCI) in Non-ST-segment Elevation Myocardial Infarction Patients with Coronary Artery Bypass Grafts. Circulation: Cardiovascular Interventions, 11(11), https://doi.org/10.1161/circinterventions.118.006824

• Journal Article Type: Article
• Acceptance Date: Sep 13, 2018
• Publication Date: Nov 16, 2018
• Journal: Circulation: Cardiovascular Interventions
• Print ISSN: 1941-7640
• Publisher: American Heart Association
• Peer Reviewed: Peer Reviewed
• Volume: 11
• Issue: 11
• DOI: https://doi.org/10.1161/circinterventions.118.006824
• Keywords: comorbidity; coronary artery disease; mortality; myocardial infarction; percutaneous coronary intervention
• Publisher URL: https://doi.org/10.1161/circinterventions.118.006824