Reperfusion Delays More Likely in STEMI Patients With Previous CABG

HealthDay News – For patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI), those with a history of coronary artery bypass graft surgery (CABG) are more likely to have reperfusion delays, according to a study published in the December 28 issue of JACC: Cardiovascular Interventions.

Luis Gruberg, MD, from the Stony Brook University Hospital in New York, and colleagues examined 15 628 STEMI patients who underwent primary PCI at 297 sites in the United States. The authors compared door-to-balloon time delays >90 minutes and in-hospital major adverse cardiovascular and cerebrovascular events (MACCE) for patients with a history of CABG, previous PCI, or no previous revascularization.

The researchers found that patients with previous CABG were significantly older and had an increased likelihood of having multiple comorbidities (P<.0001). Compared to patients with no previous revascularization, previous CABG correlated with a lower likelihood of door-to-balloon times ≤90 minutes. Patients with previous PCI and those without previous revascularization had no significant differences in door-to-balloon times. Patients with a history of CABG had an increased unadjusted MACCE risk compared to those without previous revascularization (odds ratio, 1.68); no significant difference in MACCE risk was seen after multivariable risk adjustment, however. In-hospital outcomes did not differ significantly for patients with a previous PCI and those without previous revascularization.

“Mechanisms to optimize door-to-balloon time and improve success of reperfusion in patients with previous CABG should be a priority for future research,” the authors wrote.

Disclosures: Several authors disclosed financial ties to the pharmaceutical industry.

References

  1. Douglas JS Jr. Timely primary percutaneous coronary intervention. A call to action in the post-coronary artery bypass graft patient. JACC Cardiovasc Interv. 2015:8(15):1963-1965. doi:10.1016/j.jcin.2015.09.018.
  2. Gruberg L, Hellkamp AS, Thomas LE, et al. The association of previous revascularization with in-hospital outcomes in acute myocardial infarction patients. Results from the National Cardiovascular Data Registry. JACC Cardiovasc Interv. 2015;8(15):1954-1962. doi:10.1016/j.cin.2015:08.030.