title: Outcomes Following Primary Percutaneous Coronary Intervention in Patients With Previous Coronary Artery Bypass Surgery.
abstract: BACKGROUND
  There are limited data on outcomes of patients with previous coronary artery bypass grafting (CABG) presenting with ST-segment-elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PPCI). We report outcomes in patients with STEMI undergoing PPCI with or without previous CABG surgery in a large real-world, all-comer population.
  
  
  RESULTS
  Clinical, demographic, procedural, and outcomes data were collected for all patients undergoing PPCI in England and Wales from January 2007 to December 2012. All-cause mortality at 30 days and 1 year were evaluated in the whole and a propensity-matched cohort. Of 79 295 patients with STEMI studied, 2658 (3.4%) patients had prior CABG, of whom 44% (n=1168) underwent PPCI to native vessels and 56% (n=1490) to bypass grafts. There were significant differences in the demographic, clinical, and procedural characteristics of these groups. Patients with prior CABG (with primary PCI to native artery or graft) had higher mortality at 30 days (6.2% with PPCI to native artery, 6.1% with PPCI to bypass graft) than patients with no prior CABG (4.5%; P<0.001). However, after risk factor adjustments, there was no significant difference in outcomes. There were also no significant differences in 30-day mortality, in-hospital major adverse cardiovascular events, in-hospital stroke, and in-hospital bleeding in the propensity-matched population.
  
  
  CONCLUSIONS
  A prior history of CABG in patients presenting with STEMI and undergoing PPCI does not independently confer additional risk of mortality, although it is a marker of other high-risk features.
authors.affiliation: From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK (C.S.K., M.A.M.); Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands NHS Trust, UK (C.S.K., M.G., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); and Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (M.G., A.Z.).
authors.forename: Javaid
authors.initials: J
authors.lastname: Iqbal
authors.affiliation: From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK (C.S.K., M.A.M.); Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands NHS Trust, UK (C.S.K., M.G., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); and Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (M.G., A.Z.).
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK (C.S.K., M.A.M.); Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands NHS Trust, UK (C.S.K., M.G., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); and Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (M.G., A.Z.).
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kontopantelis
authors.affiliation: From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK (C.S.K., M.A.M.); Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands NHS Trust, UK (C.S.K., M.G., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); and Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (M.G., A.Z.).
authors.forename: Mark A
authors.initials: MA
authors.lastname: de Belder
authors.affiliation: From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK (C.S.K., M.A.M.); Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands NHS Trust, UK (C.S.K., M.G., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); and Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (M.G., A.Z.).
authors.forename: Peter F
authors.initials: PF
authors.lastname: Ludman
authors.affiliation: From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK (C.S.K., M.A.M.); Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands NHS Trust, UK (C.S.K., M.G., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); and Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (M.G., A.Z.).
authors.forename: Marilena
authors.initials: M
authors.lastname: Giannoudi
authors.affiliation: From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK (C.S.K., M.A.M.); Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands NHS Trust, UK (C.S.K., M.G., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); and Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (M.G., A.Z.).
authors.forename: Mark
authors.initials: M
authors.lastname: Gunning
authors.affiliation: From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK (C.S.K., M.A.M.); Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands NHS Trust, UK (C.S.K., M.G., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); and Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (M.G., A.Z.).
authors.forename: Azfar
authors.initials: A
authors.lastname: Zaman
authors.affiliation: From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK (C.S.K., M.A.M.); Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands NHS Trust, UK (C.S.K., M.G., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); and Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (M.G., A.Z.). mamasmamas1@yahoo.co.uk.
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D004739:England; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014852:Wales
keywords: cardiovascular disease; coronary artery bypass graft; mortality; percutaneous coronary intervention; saphenous vein graft