832 Graft Versus Native Vessel Intervention for Patients With Previous Bypass Surgery Undergoing Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction

Abstract

Patients with previous coronary artery bypass graft (CABG) represent a high risk substrate for primary percutaneous coronary intervention (PPCI) in ST-elevation myocardial infarction (STEMI). We sought to determine whether outcomes differed between native vessel vs graft PPCI in patients with prior CABG at our institution. All patients between June 2010 and December 2018 presenting with STEMI to our tertiary centre were reviewed. There were 1837 patients treated with PPCI, of which 98 patients (5.3%) had previous CABG and were included in the study. Data were collected on baseline and procedural characteristics and major adverse cardiovascular events (MACE). In total, there were 49 graft and 49 native vessel interventions. Mean follow-up duration was 22 months. There were no significant differences in baseline characteristics. MACE-free survival was superior in the native vessel PPCI group compared to the graft PPCI group (75.5% vs 53%; HR 1.92; p=0.02). There was a 14.3% mortality rate for which was equal across the two groups. MACE was largely driven by target vessel revascularisation in the native vessel PPCI arm (33.3% of MACE vs 26.1%; p=0.4) and recurrent myocardial infarction in the graft PPCI arm (39% of MACE vs 25%; p=0.4). In patients presenting with STEMI and previous CABG, native vessel intervention is associated with superior outcomes compared to graft intervention. Native vessel intervention should be considered when possible in the setting of STEMI.