Abstract
ObjectivesClinical characteristics and trends in the outcome of acute coronary syndrome (ACS) in patients with prior coronary artery bypass graft surgery (CABG) are unclear. The aim of this study was to evaluate clinical characteristics, in-hospital treatment, and outcomes in patients presented with ACS with or without a history of prior CABG over 2 decades.MethodsData were derived from hospital-based study for collected data from 1991 through 2010 of patients hospitalized with ACS in Doha, Qatar. Data were analyzed according to their history of prior CABG. Baseline clinical characteristics, in-hospital treatment, and outcome were compared.ResultsA total 16,750 consecutive patients with ACS were studied, of which 693 (4.1%) had prior CABG. Patients with prior CABG were older (mean 60.5±11 vs. 53±12 years; P = 0.001), more likely to be females and have more cardiovascular risk factors than the non-CABG group. Prior CABG patients had larger infarct size, were less likely to receive reperfusion therapy, early invasive therapy and more likely to receive evidence-based therapies when compared to non-CABG patients. In-hospital mortality and stroke rates were comparable between the 2 groups. Over 2 decades, there was reduction in the in-hospital mortality rates and stroke rates in both groups (CABG, death; 13.2% to 4%, stroke; 1.9% to 0.0%, non-CABG, death; 10% to 3.2%, stroke 1.0% to 0.1%; all, p = 0.001).ConclusionSignificant reduction in-hospital morbidity and mortality among ACS patients with prior CABG over a 20-year period.
Highlights
There is a growing global attention concerning the short and long term prognosis of acute coronary syndrome (ACS) in patients with prior coronary artery bypass grafting (CABG)
We hypothesize that the clinical characteristics, treatment and outcome of ACS patients with prior CABG to be different than patients without prior CABG
Our second hypothesis is that the improvement in the surgical techniques of CABG and increase use of evidence-based therapy over the past two decades resulted in significant reduction in morbidity and mortality of ACS patients with prior CABG
Summary
There is a growing global attention concerning the short and long term prognosis of acute coronary syndrome (ACS) in patients with prior coronary artery bypass grafting (CABG). A recent global rising in the number of ACS was observed in patients with prior CABG [10], as a result of the worldwide increasing numbers of bypass surgeries performed annually [11,12] and in the consequences of the angiographically recognized loss of vein graft after surgery (50% become diseased and 25% occluded) by 5 years [2].
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