A024 Coronary Angiography and Percutaneous Coronary Intervention After Acute Coronary Syndrome in Patients With Prior CABG – A National Audit using ANZACS-QI

Abstract

Coronary angiography (CA) in patients with previous coronary artery bypass grafts (CABG) is technically more difficult and has been linked to higher in-hospital complications and mortality. Our aim is to describe the characteristics, coronary angiography findings and percutaneous coronary interventional (PCI) management in patients with prior CABG undergoing coronary angiography post-ACS. The All NZ Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry was used to identify patients admitted to NZ public hospitals with a first ACS event who underwent invasive CA between September 2014 and December 2018. We compared ACS patients with and without with prior CABG. Of 57,357 ACS patients, 3,573 (6%) had prior CABG. Patients with prior CABG were older than those without CABG (71y vs. 65y, p<0.01) and more likely to be male (82% vs. 66%, p<0.01). The use of radial artery access for CA was lower in those with prior CABG than for those without prior CABG (50% vs. 89%, p<0.01). PCI use was similar in both groups (35% vs. 36%, p=0.04). Of the 1264 patients with prior CABG who were treated with PCI, 64% had PCI to the native coronary artery only, 31% had PCI to a coronary graft, and 61 (5%) had PCI to both native vessel and graft. Half of patients with prior CABG were studied via the radial artery route. A third of patients with prior CABG received a PCI, a rate similar to those without prior CABG, and of these, two-thirds received intervention to a native coronary artery.