PURPOSE: To characterize acute coronary syndrome (ACS) patients with previous coronary artery bypass grafting (CABG) and to compare the in and out of hospital outcome with those without previous CABG.
METHODS: Continuous prospective observational study of 1459 consecutively admissions for an acute coronary syndrome in a single coronary care unit, between May 2004 and December 2006, with a mean follow up of 19 months. Patients were divided in two groups: A (N=1223) –no previous CABG; and B (N=73) –previous CABG.
RESULTS: The median time after CABG for the present ACS were 9 (4–12) years. Group B patients were more often male (86.3 versus 69.1 p=0.002), with more frequent past history of diabetes (OR 1.72 p=0.028), previous infarction and heart failure (OR 4.17 p=0.05). They also had, as expected, a worse coronary anatomy, with a significant number o lesions in the grafts, but both groups were equally likely to be treated with stents. No difference was noted between groups with respect to the use of an invasive strategy, and to the anti-platelet therapy. Group A had more ST elevation acute myocardial infarction (36.4 vs 8.7%, p<0.001), higher ejection fraction (50.94+/−11.36 versus 46.32+/−11.76 p=0.001), peak troponin I levels. Group A patients were more likely to be discharge on statins and double anti-platelet therapy. No significant difference were noticed in terms of in-hospital (5.9% versus 9, 5%, p=0.20), one month, six months and one year overall mortality. The cumulative freedom from MACE, one year after the ACS, were similar between groups (82.6 vs 78.0% log rank p=0.37). Post CABG patients had a lower freedom from a re-admission for unstable angina in the year after (96.9 vs 88.7%, log rank p<0.001).
CONCLUSION: In this patient population, the presence of previous CABG did not significantly influenced short and long-term outcome, probably because of the frequent use of PCI and stenting in the CABG population.
CLINICAL IMPLICATIONS: This result emphasizes the need for aggressive treatment in this ACS subpopulation.
DISCLOSURE: Rogerio Teixeira, No Financial Disclosure Information; No Product/Research Disclosure Information