Angioplasty Outcomes Poor in Patients With Prior Bypass Surgery

Patients with prior coronary artery bypass grafting (CABG) who undergo primary angioplasty for acute myocardial infarction are at increased risk of major adverse events and mortality, cardiologists report in the September issue of the American Heart Journal. The reason is largely due to adverse baseline characteristics and the need for vein graft treatment.

Dr. David R. Holmes, Jr., and colleagues from the Mayo Clinic, Rochester, Minnesota analyzed outcomes after primary percutaneous coronary interventions in 128 AMI patients who had already undergone CABG and 944 AMI patients who had not.

Compared with patients without prior CABG, those with prior CABG were significantly older and more often had diabetes, hypertension and hypercholesterolemia. They also had lower left ventricular ejection fractions and were more likely to have congestive heart failure.

The mortality rate 1 year after angioplasty was significantly higher in patients with prior CABG than patients without, at 25.8% versus 12.2%, respectively, according to the team. CABG patients also had higher rates of major adverse cardiovascular events at 1 year than did patients without CABG, at 49.2% versus 35.9%, respectively.

On multivariate analysis, treatment of a vein graft was independently associated with adverse cardiac events, relative risk 1.48 (p = .02), they report.

“Clearly, more aggressive secondary prevention as well as safer and more durable interventional strategies are needed for this patient population,” Dr. Holmes’ and colleagues conclude.

Dr. Bruce R. Brodie, of the Moses H. Cone Memorial Hospital, Greensboro, North Carolina, agrees. Improved outcomes, he writes in an accompanying editorial, may come from the use of stents, extraction atherectomy and thrombectomy devices, as well as distal protection devices.

Am Heart J 2001;142:381-383,452-459.