title: Can we improve outcomes in patients with previous coronary artery bypass surgery admitted for acute coronary syndrome?
abstract: OBJECTIVE
  Prognosis and in-hospital management of patients with acute coronary syndrome (ACS) and a history of coronary artery bypass graft (CABG) surgery are still debated. The objective of this study was to characterize ACS patients with a CABG and to compare their in-hospital and postdischarge outcomes with those of patients without a CABG.
  
  
  METHODS
  This ongoing prospective observational study included 1,495 consecutive patients admitted for ACS to a coronary care unit and followed up for a mean of 19 months. There were two groups: group A (n=73), with CABGs; and group B (n=1,223), without CABGs.
  
  
  RESULTS
  Group A patients were more often male (86.3% versus 69.1%; P=.002), and more frequently had a history of diabetes, myocardial infarction and heart failure. Group B patients more frequently had ST-elevation myocardial infarction, and had a higher median ejection fraction (53% [interquartile range, 47%-60%] vs. 50% [42%-55%]; P< .01) and peak troponin-I concentration. There was no difference in the use of invasive techniques. Regarding medication, Group B patients were more likely to receive dual antiplatelet therapy at discharge. No significant difference was observed in in-hospital mortality (9.5% versus 5.9%; P=.2) or mortality at 1 month, 6 months or 1 year (9.8% versus 9.1%; log-rank test, P=.87) and the cumulative major adverse cardiac event rate was equally low in both groups. The presence of a CABG was associated with more readmissions for unstable angina (11.3% vs. 3.1%; P< .01).
  
  
  CONCLUSIONS
  In our ACS patients, the presence of a CABG had no significant influence on short- or medium-term outcomes, such as all-cause mortality and adverse cardiac events.
authors.affiliation: Unidad de Cuidados Coronarios, Hospital Universitario, Coimbra, Portugal. rogeriopteixeira@gmail.com
authors.forename: Rogério
authors.initials: R
authors.lastname: Teixeira
authors.forename: Carolina
authors.initials: C
authors.lastname: Lourenço
authors.forename: Natália
authors.initials: N
authors.lastname: António
authors.forename: Elisabete
authors.initials: E
authors.lastname: Jorge
authors.forename: Rui
authors.initials: R
authors.lastname: Baptista
authors.forename: Fátima
authors.initials: F
authors.lastname: Saraiva
authors.forename: Paulo
authors.initials: P
authors.lastname: Mendes
authors.forename: Sílvia
authors.initials: S
authors.lastname: Monteiro
authors.forename: Francisco
authors.initials: F
authors.lastname: Gonçalves
authors.forename: Pedro
authors.initials: P
authors.lastname: Monteiro
authors.forename: Mario
authors.initials: M
authors.lastname: Freitas
authors.forename: Luís A
authors.initials: LA
authors.lastname: Providência
mesh_terms: D054058:Acute Coronary Syndrome / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood
chemical_list: D014336:Troponin