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Abstract
Background Patients with prior coronary artery bypass graft surgery (CABG) are at increased risk for recurrent cardiovascular ischaemic events. Advances in management have improved prognosis of patients with acute coronary syndrome (ACS), yet it is not known whether similar trends exist in patients with prior CABG.
Aim Examine temporal trends in the prevalence, treatment and clinical outcomes of patients with prior CABG admitted with ACS.
Methods Time-dependent analysis of patients with or without prior CABG admitted with an ACS who enrolled in the ACS Israeli Surveys between 2000 and 2016. Surveys were divided into early (2000–2008) and late (2010–2016) time periods. Outcomes included 30 days major adverse cardiac events (30d MACE) (death, myocardial infarction, stroke, unstable angina, stent thrombosis, urgent revascularisation) and 1-year mortality.
Results Among 15 152 patients with ACS, 1506 (9.9%) had a prior CABG. Patients with prior CABG were older (69 vs 63 years), had more comorbidities and presented more with non-ST elevation-ACS (82% vs 51%). Between time periods, utilisation of antiplatelets, statins and percutaneous interventions significantly increased in both groups (p<0.001 for each). The rate of 30d MACE decreased in patients with (19.1%–12.4%, p=0.001) and without (17.4%–9.5%, p<0.001) prior CABG. However, 1-year mortality decreased only in patients without prior CABG (10.5% vs 7.4%, p<0.001) and remained unchanged in patients with prior CABG. Results were consistent after propensity matching.
Conclusions Despite an improvement in the management and prognosis of patients with ACS in the last decade, the rate of 1-year mortality of patients with prior CABG admitted with an ACS remained unchanged.
- cardiac catheterisation and angiography
- coronary artery disease surgery
- cardiac risk factors and prevention
- acute coronary syndromes
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Footnotes
Contributors All authors had access to data and a role in writing the manuscript. IM and AE contributed as guarantors of overall content and manuscript writing. IM and AE contributed together with IG, TC and NS in the planning, conducting and reporting of the work described herein. OZ contributed in the statistical analysis. RK, HV and AA contributed during patients' recruitment and catheterisation. ZI contributed in the medical treatment of recruited patients.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Surveys were performed and reviewed by an ethics committee from Sheba—Tel Ha Shomer hospital webpage as follow: https://www.health.gov.il/English/MinistryUnits/ICDC/Chronic_Diseases/Heart_diseases/Pages/ACSIS.aspx. All patients signed an informed consent for participating in the ACSIS registry in each medical centre.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information (https://www.health.gov.il/English/MinistryUnits/ICDC/Chronic_Diseases/Heart_diseases/Pages/ACSIS.aspx).
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
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