Patients with prior coronary artery bypass grafting have a poor outcome after myocardial infarction: an analysis of the VALsartan in acute myocardial iNfarcTion trial (VALIANT).
OBJECTIVE
The number of patients presenting with an acute myocardial infarction (MI) and prior coronary artery bypass grafting (CABG) is increasing. We compared the baseline characteristics, treatment, and clinical outcomes of patients with and without prior CABG in the VALIANT trial.


RESULTS
Of the 14 703 patients with heart failure (HF), left ventricular systolic dysfunction, or both enrolled in VALIANT, 1026 (7%) had prior CABG. Prior CABG patients were older [mean age (SD): 67 (10) vs. 65 (12) years; P < 0.0001], had more comorbidity, and more frequent non-Q wave MI (66 vs. 30%; P < 0.0001). At hospital presentation, prior CABG patients received less aspirin (82 vs. 90%; P < 0.0001) and thrombolysis (21 vs. 36%; P < 0.0001), but had a similar rate of primary percutaneous coronary intervention (14 vs. 15%; P = 0.2). Prior CABG patients were more likely to experience the composite outcome of cardiovascular death, MI, HF, resuscitated cardiac arrest, or stroke; 3 year Kaplan-Meier rate, 64 vs. 39% (adjusted hazard ratio 1.29, 95% confidence interval 1.17-1.43; P < 0.0001).


CONCLUSIONS
Patients with prior CABG had a worse clinical profile and experienced more fatal and non-fatal outcomes. Greater recognition is necessary for these high-risk patients including optimization of evidence-based secondary preventive therapy.
Berry
Colin
C
Faculty of Medicine, BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK.
Pieper
Karen S
KS
White
Harvey D
HD
Solomon
Scott D
SD
Van de Werf
Frans
F
Velazquez
Eric J
EJ
Maggioni
Aldo P
AP
Califf
Robert M
RM
Pfeffer
Marc A
MA
McMurray
John J V
JJ
D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D016896:Treatment Outcome