Original Article

Does Invasive Treatment Increase the Long-term Survival of ST-Elevation Myocardial Infarction Patients with a History of Coronary Artery Bypass Graft Surgery?

Abstract

Background: Although invasive treatments such as primary percutaneous coronary intervention (PPCI) are the treatment of choice in ST-elevation myocardial infarction (STEMI) patients, the survival benefit of this treatment in patients with a history of coronary artery bypass graft (CABG) has yet to be fully evaluated.
Methods: In this historical cohort study, 251 STEMI patients with a history of CABG between 2007 and 2017 were stratified into 3 groups of no reperfusion, thrombolytic, and PPCI based on their treatment strategy. Baseline clinical characteristics, details of the STEMI event, and the course of hospitalization were evaluated for all patients and they were followed up until May 2018 to assess all-cause mortality.
Results: The mean age of the study population was 64.01±9.45 years, and 81.7% of them were male. The median follow-up time was 1304 (IQR25%-75%: 571–2269) days, the short-term (1 month) mortality rate was 5.97%, and the long-term mortality rate was 15.1%. There was no significant difference between the 3 different strategies in terms of survival. In the fully adjusted multivariate analysis, cardiopulmonary resuscitation (HR: 15.06, 95% CI: 2.25–101.14, P=0.005) was significantly associated with short-term mortality, while diabetes (HR: 5.95, 95% CI: 2.03–17.44, P=0.001), opium abuse (HR: 4.85, 95% CI: 1.45–16.23, P=0.010), and cardiopulmonary resuscitation (HR: 11.73, 95% CI: 3.44–40.28, P=0.001) were significantly associated with long-term mortality.
Conclusion: Our results failed to show the superiority of invasive treatment in terms of survival. Further studies regarding the advantages and disadvantages of invasive treatment in post-CABG patients are required.

Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European heart journal. 2017;39(2):119-77.

Mehta RH, Granger CB, Alexander KP, et al. Reperfusion strategies for acute myocardial infarction in the elderly: benefits and risks. Journal of the American College of Cardiology. 2005;45(4):471-8.

Valente S, Lazzeri C, Salvadori C, et al. Effectiveness and safety of routine primary angioplasty in patients aged≥ 85 years with acute myocardial infarction. Circulation Journal. 2008;72(1):67-70.

Welsh RC, Granger CB, Westerhout CM, et al. Prior coronary artery bypass graft patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. JACC: Cardiovascular Interventions. 2010;3(3):343-51.

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: Cardiovascular Interventions. 2015;8(15):1954-62.

Iqbal J, Kwok CS, Kontopantelis E, et al. Outcomes following primary percutaneous coronary intervention in patients with previous coronary artery bypass surgery. Circulation: Cardiovascular Interventions. 2016;9(4):e003151.

Kohl LP, Garberich RF, Yang H, et al. Outcomes of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction patients with previous coronary bypass surgery. JACC: Cardiovascular Interventions. 2014;7(9):981-7.

Szummer K, Lundman P, Jacobson S, et al. Influence of renal function on the effects of early revascularization in non-ST-elevation myocardial infarction: data from the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). Circulation. 2009;120(10):851.

Group EMIP. Prehospital thrombolytic therapy in patients with suspected acute myocardial infarction. New England Journal of Medicine. 1993;329(6):383-9.

Zijlstra F, Hoorntje JC, de Boer M-J, et al. Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction. New England Journal of Medicine. 1999;341(19):1413-9.

Grines CL, Browne KF, Marco J, et al. A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. New England Journal of Medicine. 1993;328(10):673-9.

Investigators G. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. New England Journal of Medicine. 1993;329(10):673-82.

Gibbons RJ, Holmes DR, Reeder GS, et al. Immediate angioplasty compared with the administration of a thrombolytic agent followed by conservative treatment for myocardial infarction. New England Journal of Medicine. 1993;328(10):685-91.

Every NR, Parsons LS, Hlatky M, Martin JS, Weaver WD. A comparison of thrombolytic therapy with primary coronary angioplasty for acute myocardial infarction. New England Journal of Medicine. 1996;335(17):1253-60.

Sen H, Lam MK, Tandjung K, et al. Impact of previous coronary artery bypass surgery on clinical outcome after percutaneous interventions with second generation drug-eluting stents in TWENTE trial and Non-Enrolled TWENTE registry. International journal of cardiology. 2014;176(3):885-90.

Bundhoo SS, Kalla M, Anantharaman R, et al. Outcomes following PCI in patients with previous CABG. Catheterization and Cardiovascular Interventions. 2011;78(2):169-76.

Zorbozan O, Cevik AA, Acar N, et al. Predictors of mortality in ST-elevation MI patients: A prospective study. Medicine. 2018;97(9).

Cretu Diana E, Udroiu Cristian A, Stoicescu Claudiu I, Tatu-Chitoiu Gabriel VD. Predictors of in-Hospital Mortality of ST-Segment Elevation Myocardial Infarction Patients Undergoing Interventional Treatment. An Analysis of Data from the RO-STEMI Registry. Maedica. 2015;10(4):295.

Schmucker J, Wienbergen H, Seide S, et al. Identification of predictors of 1-year mortality after ST-elevation myocardial infarction-results from the Bremen STEMI-registry. European Heart Journal. 2013;34(suppl_1):P1317.

Bienert IRdC, Ribeiro HB, Valim LR, et al. In-hospital outcomes and predictors of mortality in acute myocardial infarction with cardiogenic shock treated by primary angioplasty: data from the InCor registry. Revista Brasileira de Cardiologia Invasiva. 2012;20(1):41-5.

Falcao FJdA, Alves CMR, Barbosa AHP, et al. Predictors of in-hospital mortality in patients with ST-segment elevation myocardial infarction undergoing pharmacoinvasive treatment. Clinics. 2013;68(12):1516-20.

Bărcan A, Chițu M, Benedek E, et al. Predictors Of Mortality In Patients With ST-Segment Elevation Acute Myocardial Infarction And Resuscitated Out-Of-Hospital Cardiac Arrest. The Journal of Critical Care Medicine. 2016;2(1):22-9.

Hosseini SK, Masoudkabir F, Vasheghani-Farahani A, et al. Opium consumption and coronary atherosclerosis in diabetic patients: a propensity score-matched study. Planta medica. 2011;77(17):1870-5.

Khademi H, Malekzadeh R, Pourshams A, et al. Opium use and mortality in Golestan Cohort Study: prospective cohort study of 50 000 adults in Iran. Bmj. 2012;344:e2502.

Masoudkabir F, Sarrafzadegan N, Eisenberg MJ. Effects of opium consumption on cardiometabolic diseases. Nature reviews Cardiology. 2013;10(12):733.

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IssueVol 14 No 3 (2019): J Teh Univ Heart Ctr QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jthc.v14i3.1429
Keywords
Acute coronary syndrome ST elevation myocardial infarction Survival analysis Thrombolytic therapy Percutaneous coronary intervention Coronary artery bypass

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How to Cite
1.
Taghavi Shavazi M, Saadatagah S, Aghajani H, Poorhosseini H, Salarifar M, Amirzadegan A, Hajzeinali A, Alidoosti M, Aghajani R, Neamatipour E. Does Invasive Treatment Increase the Long-term Survival of ST-Elevation Myocardial Infarction Patients with a History of Coronary Artery Bypass Graft Surgery?. J Tehran Heart Cent. 2019;14(3):109-120.