Abstract 4195: Primary Angioplasty in Patients Following Coronary Artery Bypass Surgery; Trends in Application and Outcome. Results From the Acute Coronary Syndromes, Israel Survey (ACSIS) 2000–2008
Background: Primary angioplasty is the treatment of choice in patients with acute myocardial infarction, however its application and outcome in post CABG patients has not been thoroughly investigated.
Aim: To study the trends in use of primary angioplasty in the management of STEMI in post CABG patients and to evaluate its outcome in post CABG patients compared to patients with no prior surgery.
Methods: Data for patients with STEMI was obtained from the Acute Coronary Syndromes, Israel Survey (ACSIS), a biennial, two-month survey that is carried out since 1992 in all intensive coronary care units and cardiology department in Israel. Baseline characteristics, management and outcome of post-CABG patients were compared to non-post CABG patients during 2006, 2008 surveys. Percentage and outcome of patients undergoing angioplasty (post CABG compared to no-prior CABG) was obtained from the 5 surveys 2000 –2008.
Results: Total number of patients during 2000 –2008 surveys was 9781. Only 1002 (10.2%) were post-CABG (no significant change through the surveys, 8.6 –11.3%). Reperfusion therapy for post-CABG patients was consistently lower (34–48%) compared to non-post CABG (57%– 65%). Primary angioplasty as the mode of reperfusion through the 5 surveys was 0%, 37%, 60%, 70%, 83% compared to 19%, 44%, 68%, 77%, 88% respectively. Angiographic outcome for patients with STEMI who underwent primary PCI (2006, 2008 surveys) (17 post-CABG, mean age 66.6±9.1 and 821 non-post CABG, mean age 60.1±12.9). Successful outcome (TIMI flow 3) was 86% and 88% respectively. Thirty day mortality was 5.9% and 5.1% respectively (p=0.89). MACE rate was 17.6 and 12.5 respectively (p=0.54).
Conclusions: Application of primary angioplasty as the preferred mode of treatment for STEMI in post-CABG patients has increased during the past years and is approaching the rate in non-post CABG patients. Angiographic outcome of invasive treatment is equivalent in both groups despite more complicated anatomy and possibly larger thrombus burden in post CABG. Therefore, primary angioplasty is appropriate also in post-CABG patients presenting with STEMI