title: Angiographic Findings and Revascularization Success in Patients With Acute Myocardial Infarction and Previous Coronary Bypass Grafting.
abstract: Current guidelines recommend invasive coronary angiography and interventional revascularization in ST-elevation and Non-ST-elevation myocardial infarction (STEMI and NSTEMI). The aim of this study was to analyze culprit lesions and percutaneous coronary intervention (PCI) success in patients with previous coronary artery bypass grafting (CABG). We analyzed the data of 121 consecutive patients in whom coronary angiography was performed in the setting of STEMI or NSTEMI and who had previous CABG. Coronary angiograms were reviewed, and clinical data were evaluated. The culprit vessel was identified by means of electrocardiographic findings, echocardiography, and coronary angiography. A bypass graft was the culprit vessel in 86% of patients with STEMI and 68% of patients with NSTEMI. Venous grafts were culprit vessels significantly more frequently than arterial grafts (81 of 260 venous grafts vs 4 of 65 arterial grafts, p <0.001). Attempted acute PCI was successful in 97% of native arteries (31 of 32 patients) but only in 81% of bypass grafts (68 of 84 patients, p = 0.031). Overall in-hospital mortality was 13% (STEMI: 25%, NSTEMI: 10%, p <0.001) and was significantly higher after failed acute PCI (6 of 11 patients; 55%) compared with successful acute PCI (7 of 110 patients; 6%; p = 0.006). In conclusion, the culprit lesion in patients with previous CABG who present with STEMI or NSTEMI is more often located in bypass grafts than in native arteries. Successful PCI is more likely in native arteries compared with bypass grafts.
authors.affiliation: Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany. Electronic address: florian.blachutzik@uk-erlangen.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Blachutzik
authors.affiliation: Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.affiliation: Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Monique
authors.initials: M
authors.lastname: Troebs
authors.affiliation: Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Roether
authors.affiliation: Department of Cardiology, University Hospital Giessen, Giessen, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Nef
authors.affiliation: Department of Cardiology, University Hospital Giessen, Giessen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Hamm
authors.affiliation: Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schlundt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000637:transplantation; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000601:surgery; D000072658:Non-ST Elevated Myocardial Infarction / Q000000981:diagnostic imaging / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014680:Veins / Q000637:transplantation