In-hospital Outcomes of Patients With and Without Previous Coronary Artery Bypass Graft Surgery Who Present With a Non-ST-Segment Elevation Myocardial Infarction

Dhaduk, Nehal; Xia, Yuhe; Feit, Frederick; Mamas, Mamas; Alviar, Carlos; Keller, Norma; Rao, Sunil V.; Bangalore, Sripal

Abstract

The clinical course of patients with a previous coronary artery bypass graft surgery (CABG) presenting with non-ST-elevation myocardial infarction (NSTEMI) is not well defined. We aimed to compare the management and outcomes of patients with and without between 2002 and 2018 were identified from the National Inpatient Sample. The baseline characteristics and outcomes of patients with and without a previous CABG were compared. The outcomes included the rates of invasive procedures (defined as coronary angiography, percutaneous coronary intervention [PCI], or CABG), and its individual components, and in-hospital mortality. A total of 1,445,545 cases of NSTEMI were found, of which 133,691 (9.3%) had a previous CABG. Patients with a previous CABG were older (72.4 vs 68.6 years, p <0.001), more likely men (68.8% vs 56.9%, p <0.001), and of White race (79.7% vs 74.8%, p <0.001). The previous CABG cohort had lower rates of invasive procedures (50.4% vs 65.6%, p <0.001), PCI (23.7% vs 32.0%, p <0.001), or CABG (1.2% vs 10.6%; p <0.001) in the unmatched analysis. The results were consistent in the propensity score-matched analysis with the previous CABG group less likely to receive any invasive procedures (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.47 to 0.49), including coronary angiography (OR 0.54, 95% CI 0.53 to 0.55), PCI (OR 0.66, 95% CI 0.64 to 0.67), or repeat CABG (OR 0.11, 95% CI 0.10 to 0.12). Moreover, the risk of inhospital mortality was higher in the previous CABG group (OR 1.15, 95% CI 1.10 to 1.21). In the subset of patients who were revascularized in both groups, this excess mortality was no longer observed (OR 0.82, 95% CI 0.66 to 1.03). In conclusion, a previous CABG in patients who present with NSTEMI is associated with lower rates of invasive procedures and revascularization and higher in-hospital mortality than patients without a previous CABG.

Citation

Dhaduk, N., Xia, Y., Feit, F., Mamas, M., Alviar, C., Keller, N., …Bangalore, S. (2023). In-hospital Outcomes of Patients With and Without Previous Coronary Artery Bypass Graft Surgery Who Present With a Non-ST-Segment Elevation Myocardial Infarction. American Journal of Cardiology, 194, 78-85. https://doi.org/10.1016/j.amjcard.2023.02.013

• Journal Article Type: Article
• Acceptance Date: Nov 16, 2022
• Publication Date: May 1, 2023
• Deposit Date: Jun 29, 2023
• Journal: The American Journal of Cardiology
• Print ISSN: 0002-9149
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 194
• Pages: 78-85
• DOI: https://doi.org/10.1016/j.amjcard.2023.02.013
• Additional Information: This article is maintained by: Elsevier; Article Title: In-hospital Outcomes of Patients With and Without Previous Coronary Artery Bypass Graft Surgery Who Present With a Non-ST-Segment Elevation Myocardial Infarction; Journal Title: The American Journal of Cardiology; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.amjcard.2023.02.013; Content Type: article; Copyright: © 2023 Published by Elsevier Inc.