title: The role of angioplasty in patients with acute coronary syndrome and previous coronary artery bypass grafting.
abstract: BACKGROUND
  Angioplasty has changed the management of acute coronary syndrome (ACS). However, in patients with previous coronary artery bypass grafting (CABG), the role of angioplasty in the management of ACS is widely debated. Lack of clear guidelines leads to subjective and often stereotypical assessments based on clinician preferences. We sought to investigate if angioplasty affected all cause mortality in ACS patients with previous CABG.
  
  
  METHODS
  Completely anonymous information on patients with ACS with a background of previous CABG, co-morbidities and procedures attending three multi-ethnic general hospitals in the North West of England, United Kingdom in the period 2000-2012 was traced using the ACALM (Algorithm for Comorbidities, Associations, Length of stay and Mortality) study protocol using ICD-10 and OPCS-4 coding systems. Predictors of mortality and survival analyses were performed using SPSS version 20.0.
  
  
  RESULTS
  Out of 12,227 patients with ACS, there were 1172 (19.0%) cases of ACS in patients with previous coronary artery bypass grafting. Of these 83 (7.1%) patients underwent angioplasty. Multi-nominal logistic regression, accounting for differences in age and co-morbidities, revealed that having angioplasty conferred a 7.96 times improvement in mortality (2.36-26.83 95% CI) compared to not having angioplasty in this patient group.
  
  
  CONCLUSIONS
  We have shown that angioplasty confers significantly improved all cause mortality in the management of ACS in patients with previous CABG. The findings of this study highlight the need for clinicians to conscientiously think about the individual benefits and risks of angioplasty for every patient rather than confining to age related stereotypes.
authors.affiliation: ACALM Study Unit in collaboration with Aston Medical School, Aston University, Birmingham, UK. Electronic address: rahulpotluri@outlook.com.
authors.forename: Rahul
authors.initials: R
authors.lastname: Potluri
authors.affiliation: Department of Cardiology, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.
authors.forename: Mudassar
authors.initials: M
authors.lastname: Baig
authors.affiliation: Department of Medicine, Royal Wolverhampton Hospital, Wolverhampton, UK.
authors.forename: Jaskaran Singh
authors.initials: JS
authors.lastname: Mavi
authors.affiliation: Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK.
authors.forename: Noman
authors.initials: N
authors.lastname: Ali
authors.affiliation: Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK.
authors.forename: Amir
authors.initials: A
authors.lastname: Aziz
authors.affiliation: ACALM Study Unit in collaboration with Aston Medical School, Aston University, Birmingham, UK.
authors.forename: Hardeep
authors.initials: H
authors.lastname: Uppal
authors.affiliation: Department of Acute Medicine, North Western Deanery, Manchester, UK.
authors.forename: Suresh
authors.initials: S
authors.lastname: Chandran
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality / Q000639:trends*; D016022:Case-Control Studies; D001026:Coronary Artery Bypass / Q000401:mortality / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology
keywords: Acute coronary syndrome; Angioplasty; CABG; Mortality