title: Outcomes of Primary Percutaneous Coronary Intervention for Patients with Previous Coronary Artery Bypass Grafting Presenting with STsegment Elevation Myocardial Infarction.
abstract: BACKGROUND
  There are limited data on outcomes of patients with previous coronary artery bypass grafting (CABG) presenting acutely as ST-segment elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PPCI).
  
  
  OBJECTIVE
  To compare outcomes in STEMI patients undergoing PPCI with or without previous CABG surgery.
  
  
  METHODS
  An all-comer single-centre observational registry from a cardiothoracic centre in UK. All consecutive patients presenting for PPCI between 2007 and 2012 were included. Electronic records were used to extract relevant information. Mortality data were obtained from the Office of National Statistics. Overall median follow-up period was 1.7 years (intraquartile range 0.9-2.5).
  
  
  RESULTS
  Complete data were available for 2133 (97%) patients. 47-patients had previous history of CABG. Out of these, the infarct related artery (IRA) was native vessel in 22 and graft in 25 patients. Post re-vascularization TIMI flow was inferior in CABG cohort (<TIMI 3 flow in 17% vs. 10%, p=0.012) and they were less likely to achieve acute reperfusion (TIMI 0 in 9% vs. 3%, p=0012). In-hospital-mortality was not different in both groups (2%vs.4%, p=0.23). 30-day (HR 0.54; 95%CI 0.17-1.73; P=0.301), 1-year-mortality (HR 0.77; 95%CI 0.31-1.87; P=0.56) and over a median follow-up of 1.7 years (HR 1.1; 95%CI 0.54-2.27; P=0.79) were also not different.
  
  
  CONCLUSIONS
  Patients presenting with STEMI to PPCI service with history of CABG are less likely to achieve acute reperfusion and have worse angiographic outcomes. Post PPCI, the prior CABG patients do not seem to have worse shortterm and long-term prognosis.
authors.affiliation: Department of Cardiology and Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road S5 7AU, UK.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Garg
authors.affiliation: Department of Cardiology and Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road S5 7AU, UK.
authors.forename: Hazlyna
authors.initials: H
authors.lastname: Kamaruddin
authors.affiliation: Department of Cardiology and Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road S5 7AU, UK; Department of Cardiovascular Science, University of Sheffield, Medical School, Beech Hill Road, S10 2RX, UK.
authors.forename: Javaid
authors.initials: J
authors.lastname: Iqbal
authors.affiliation: Department of Cardiology and Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road S5 7AU, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Wheeldon
keywords: Acute myocardial infarction/STEMI; Primary PCI.; coronary bypass grafts