Abstract 16670: Outcomes of Patients With St Elevation Myocardial Infarction and History of Prior Coronary Artery Bypass Graft Surgery

Abstract

Introduction: The outcomes of ST elevation myocardial infarction (STEMI) patients with prior coronary bypass graft (CABG) surgery have received limited study. Methods: We compared the clinical and procedural characteristics and outcomes of STEMI patients with and without prior CABG surgery in a contemporary STEMI registry of consecutive STEMI patients with STEMI or new left bundle-branch block within 24 hours of symptom onset presenting between March 2003 and April 2020. Morality and major cardiac adverse events (MACE: death, MI or stroke) were the primary outcomes of the study. Survival curves are depicted using the Kaplan-Meier method and compared with log-rank test. Results: Of the 6,311 patients included in the analyses, 6.9% had history of prior CABG. Mean age was 63.4 ± 13.9 years and most of the patients were men (71%), 21% had prior MI and 19% had diabetes mellitus. Prior CABG patients were older (70.4±11.7 vs. 62.9±13.9 years, p<0.001) and more likely to have diabetes (39% vs. 18%, p<0.001), prior MI (68% vs. 18%, p<0.001) and cardiogenic shock at presentation (14% vs. 9%, p=0.001) compared with patients without CABG. Median door to balloon time (69 [52, 88] vs. 55 [41, 79] min, p<0.001) as well as length of hospital stay (3 [2, 5] vs. 3 [2, 4] days, p=0.032) were longer in prior CABG patients. Survival evaluated by the Kaplan Meier method at 30 days, 1 year, and 5 years were significantly lower in patients with prior CABG (p<0.001, Figure). Landmark survival analyses, with landmark time of hospital discharge, were similar at 30 days (p=0.158) but showed lower survival rates at 1 year and 5 years. MACE occurred with similar incidence at 30 days follow up, but were more common at 1 year follow up. Outcomes were similar to saphenous vein graft and native coronary culprits. Conclusions: Patients with STEMI and previous CABG represent a higher risk cohort with worse in-hospital and long-term outcomes compared to those without previous CABG.