History of CABG Linked to Reperfusion Delays in STEMI
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 Dec. 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<0.0001). 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 write.
Several authors disclosed financial ties to the pharmaceutical industry.