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Primary angioplasty in patients following coronary artery bypass surgery
Author(s) -
Neuman Yoram,
Pereg David,
Boyko Valentina,
Behar Solomon,
Mosseri Morris
Publication year - 2011
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.23029
Subject(s) - medicine , timi , mace , cardiology , myocardial infarction , conventional pci , angioplasty , culprit , artery , thrombus
Objectives : We aimed to study the trends in management and outcome of post CABG patients presenting with acute MI. Background: Primary angioplasty is the treatment of choice in patients with acute myocardial infarction. Saphenous vein grafts used for CABG are large‐diameter conduits that tend to accumulate a large mass of thrombus when they are the culprit artery for acute myocardial infarction (MI). We hypothesized that performing PCI in these patients is more complex and possibly results in worse outcome compared to non‐CABG patients. Methods : Data for patients with STEMI was obtained from five acute coronary syndromes Israeli biennial Surveys (ACSIS) during 2000–2008. Baseline characteristics, management and outcome of post‐CABG patients were compared to non‐post CABG patients during 2006–2008 surveys. Results : A total of 9,781 patients were included. About 1,002 (10.2%) were post‐CABG. Reperfusion therapy for post‐CABG patients (34–48%) was consistently lower compared to non‐CABG patients (57–65%). Angiographic outcome in patients with STEMI who underwent primary PCI (17 post‐CABG, mean age 66.6 ± 9.1 and 821 non‐CABG, age 60.1 ± 12.9) was successful (TIMI flow 3) in 86 and 88%, respectively. Thirty‐day mortality was 5.9 and 5.1% ( P = 0.89) and MACE rates were 17.6 and 12.5%, respectively ( P = 0.54). Conclusions : Use of primary PCI in post‐CABG patients was lower than in non‐CABG patients but increased steadily and to a similar extent in both groups. Angiographic and clinical outcome was similar despite assumingly larger thrombus burden in post CABG patients. Therefore, primary angioplasty is appropriate also in post‐CABG patients presenting with STEMI. © 2011 Wiley‐Liss, Inc.