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Prior coronary artery bypass graft patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.

Publication ,  Journal Article
Welsh, RC; Granger, CB; Westerhout, CM; Blankenship, JC; Holmes, DR; O'Neill, WW; Hamm, CW; Van de Werf, F; Armstrong, PW; APEX AMI Investigators,
Published in: JACC Cardiovasc Interv
March 2010

OBJECTIVES: We sought to compare outcomes in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) with or without previous coronary artery bypass grafts (CABG). BACKGROUND: Limited information exists regarding procedural success and clinical outcomes of STEMI patients with CABG undergoing primary PCI. METHODS: The APEX-AMI (Assessment of Pexelizumab in Acute Myocardial Infarction) trial was a randomized, placebo-controlled trial of pexelizumab in STEMI patients with planned primary PCI: 128 of 5,745 (2.2%) patients had prior CABG. Clinical/procedural characteristics, culprit vessel (infarct-related artery [IRA]), and 90-day clinical outcomes were compared. RESULTS: Patients with previous CABG were more frequently men, older, had a higher incidence of comorbidities and multivessel disease. In patients with versus without prior CABG, PCI was performed less frequently, that is, 78.9% versus 93.9%; of those with prior CABG receiving PCI, Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 was also restored less often, that is, 82.5% versus 91.6% (both p < 0.001). In prior CABG, there was a nearly even designation of the IRA as a bypass graft (n = 63) versus a native vessel (n = 55): IRA post-PCI TIMI flow grade 3 was achieved in 66.7% versus 88.0%, respectively (p = 0.043). Prior CABG patients had increased 90-day death and composite 90-day death/congestive heart failure/shock. Excess death remained significant after multivariable adjustment (hazard ratio: 1.9, 95% confidence interval: 1.08 to 3.33, p = 0.025). When prior CABG patients were stratified by the type of IRA, there was further discrimination of the increased 90-day death, that is, 19% bypass graft (n = 63) versus 5.7% native vessel (n = 55, p = 0.05), respectively. CONCLUSIONS: Prior CABG patients with STEMI are less likely to undergo acute reperfusion, have worse angiographic outcomes following primary PCI, and higher 90-day mortality. These findings are especially applicable when the IRA was a bypass graft.

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Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

March 2010

Volume

3

Issue

3

Start / End Page

343 / 351

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Single-Chain Antibodies
  • Risk Factors
  • Risk Assessment
  • Proportional Hazards Models
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
 

Citation

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Welsh, R. C., Granger, C. B., Westerhout, C. M., Blankenship, J. C., Holmes, D. R., O’Neill, W. W., … APEX AMI Investigators, . (2010). Prior coronary artery bypass graft patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. JACC Cardiovasc Interv, 3(3), 343–351. https://doi.org/10.1016/j.jcin.2009.12.008
Welsh, Robert C., Christopher B. Granger, Cynthia M. Westerhout, James C. Blankenship, David R. Holmes, William W. O’Neill, Christian W. Hamm, Frans Van de Werf, Paul W. Armstrong, and Paul W. APEX AMI Investigators. “Prior coronary artery bypass graft patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.JACC Cardiovasc Interv 3, no. 3 (March 2010): 343–51. https://doi.org/10.1016/j.jcin.2009.12.008.
Welsh RC, Granger CB, Westerhout CM, Blankenship JC, Holmes DR, O’Neill WW, et al. Prior coronary artery bypass graft patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. JACC Cardiovasc Interv. 2010 Mar;3(3):343–51.
Welsh, Robert C., et al. “Prior coronary artery bypass graft patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.JACC Cardiovasc Interv, vol. 3, no. 3, Mar. 2010, pp. 343–51. Pubmed, doi:10.1016/j.jcin.2009.12.008.
Welsh RC, Granger CB, Westerhout CM, Blankenship JC, Holmes DR, O’Neill WW, Hamm CW, Van de Werf F, Armstrong PW, APEX AMI Investigators. Prior coronary artery bypass graft patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. JACC Cardiovasc Interv. 2010 Mar;3(3):343–351.
Journal cover image

Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

March 2010

Volume

3

Issue

3

Start / End Page

343 / 351

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Single-Chain Antibodies
  • Risk Factors
  • Risk Assessment
  • Proportional Hazards Models
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate