title: Primary angioplasty in patients following coronary artery bypass surgery: trends in application and outcome. Results from the acute coronary syndrome Israeli Survey (ACSIS) 2000-2008.
abstract: OBJECTIVE
  We aimed to study the trends in management and outcome of post CABG patients presenting with acute MI.
  
  
  BACKGROUND
  Primary angioplasty is the treatment of choice in patients with acute myocardial infarction. Saphenous vein grafts used for CABG are large-diameter conduits that tend to accumulate a large mass of thrombus when they are the culprit artery for acute myocardial infarction (MI). We hypothesized that performing PCI in these patients is more complex and possibly results in worse outcome compared to non-CABG patients.
  
  
  METHODS
  Data for patients with STEMI was obtained from five acute coronary syndromes Israeli biennial Surveys (ACSIS) during 2000-2008. Baseline characteristics, management and outcome of post-CABG patients were compared to non-post CABG patients during 2006-2008 surveys.
  
  
  RESULTS
  A total of 9,781 patients were included. About 1,002 (10.2%) were post-CABG. Reperfusion therapy for post-CABG patients (34-48%) was consistently lower compared to non-CABG patients (57-65%). Angiographic outcome in patients with STEMI who underwent primary PCI (17 post-CABG, mean age 66.6 ± 9.1 and 821 non-CABG, age 60.1 ± 12.9) was successful (TIMI flow 3) in 86 and 88%, respectively. Thirty-day mortality was 5.9 and 5.1% (P = 0.89) and MACE rates were 17.6 and 12.5%, respectively (P = 0.54).
  
  
  CONCLUSIONS
  Use of primary PCI in post-CABG patients was lower than in non-CABG patients but increased steadily and to a similar extent in both groups. Angiographic and clinical outcome was similar despite assumingly larger thrombus burden in post CABG patients. Therefore, primary angioplasty is appropriate also in post-CABG patients presenting with STEMI.
authors.affiliation: Division of Cardiology, Meir Medical Center, Kfar Sava, Israel. yoram.neuman@clalit.org.il
authors.forename: Yoram
authors.initials: Y
authors.lastname: Neuman
authors.forename: David
authors.initials: D
authors.lastname: Pereg
authors.forename: Valentina
authors.initials: V
authors.lastname: Boyko
authors.forename: Solomon
authors.initials: S
authors.lastname: Behar
authors.forename: Morris
authors.initials: M
authors.lastname: Mosseri
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D019538:Health Care Surveys; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome