Revascularisation and Outcomes After Acute Coronary Syndromes in Patients with Prior Coronary Artery Bypass Grafting

Abstract

Coronary angiography in patients with previous coronary artery bypass grafts is technically more difficult and has been linked to higher complications and mortality. We plan to quantify the prevalence of prior coronary artery bypass grafting (CABG) in a contemporary cohort of patients managed with an invasive approach. We aim to study the use of myocardial revascularisation and outcomes in patients with acute coronary syndrome with and without prior CABG. The ANZACS-QI registry was used to identify patients admitted an acute coronary syndrome (ACS) event who underwent invasive coronary angiography. We compared ACS patients with and without prior CABG from 1 September 2014 to 31 October 2018. Baseline patient and angiographic characteristics were assessed. Outcomes included mortality, major bleeding, revascularisation, recurrent myocardial infarction, stroke and heart failure. Between 1 September 2014 and 31 October 2018, there were 26,869 patients admitted with ACS who underwent coronary angiography. 1,791 (6.7%) had prior CABG and 25,078 (93.3%) had no prior CABG. Prior CABG patients were older (mean age 71.3 vs 65.0 years), more likely to be male (81.3% vs 68.4%), and more co-morbid. Patients with prior CABG were less likely to be revascularised (49.8% vs 73.0%) and had higher mortality (17.3% vs 8.4% at mean follow up of 2.07 years). Rates of repeat unplanned revascularisation, recurrent MI and heart failure were higher in patients with prior CABG. Coronary angiography in ACS patients with prior CABG can be challenging due to more complex anatomy. Patients with prior CABG in this study were older, more co-morbid and more likely to be managed medically. They were also found to have poorer overall outcome.