Author + information
- Received June 1, 2015
- Revision received July 21, 2015
- Accepted August 14, 2015
- Published online December 28, 2015.
- Luis Gruberg, MD∗∗ (, )
- Anne S. Hellkamp, MS†,
- Laine E. Thomas, PhD†,
- James A. de Lemos, MD‡,
- Benjamin M. Scirica, MD§,
- Anthony Hilliard, MD‖,
- Jonathan R. Enriquez, MD¶,
- Amr Mohsen, MD# and
- Tracy Y. Wang, MD, MHS, MSc†
- ∗Department of Medicine, Division of Cardiovascular Medicine, Stony Brook University Hospital, Stony Brook, New York
- †Duke Clinical Research Institute, Durham, North Carolina
- ‡Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
- §Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
- ‖Division of Cardiology, Department of Medicine, Loma Linda University, Loma Linda, California
- ¶Division of Cardiology, Department of Medicine, University of Missouri–Kansas City, Kansas City, Missouri
- #Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan
- ↵∗Reprint requests and correspondence:
Dr. Luis Gruberg, Division of Cardiovascular Medicine, Department of Medicine, Health Sciences Center, T16-080, Stony Brook, New York 11794-8160.
Objectives The aim of this study was to compare outcomes of ST-segment elevation myocardial infarction (STEMI) patients with a history of coronary artery bypass graft surgery (CABG), previous percutaneous coronary intervention (PCI), or no previous revascularization undergoing primary PCI.
Background Limited data exist regarding door-to-balloon times and clinical outcomes of STEMI patients with a history of CABG or PCI undergoing primary PCI.
Methods We examined 15,628 STEMI patients who underwent primary PCI at 297 sites in the United States. We used multivariable logistic regression analyses to compare door-to-balloon time delays >90 min and in-hospital major adverse cardiovascular or cerebrovascular events (MACCE).
Results Patients with previous CABG were significantly older and more likely to have multiple comorbidities (p < 0.0001). Previous CABG was associated with a lower likelihood of a door-to-balloon time ≤90 min compared with patients with no previous revascularization. However, no significant differences in door-to-balloon times were noted between patients with previous PCI and those without previous revascularization. The unadjusted MACCE risk was significantly higher in patients with a history of CABG compared with patients without previous revascularization (odds ratio: 1.68, 95% confidence interval: 1.23 to 2.31). However, after multivariable risk adjustment, there were no significant differences in MACCE risk between the 2 groups. No significant differences in in-hospital outcomes were seen in patients with a previous PCI and those without previous revascularization.
Conclusions In a large cohort of STEMI patients undergoing primary PCI, patients with previous CABG were more likely to have reperfusion delays, yet risk-adjusted, in-hospital outcomes were similar to those without previous revascularization. No significant differences in reperfusion timeliness and in-hospital outcomes were seen in patients with a history of PCI compared with patients without previous revascularization.
Dr. Gruberg has received honoraria for serving on the Speakers Bureau of AstraZeneca and Janssen. Dr. Wang has received research grants to the Duke Clinical Research Institute from AstraZeneca, Boston Scientific, Daiichi-Sankyo, Eli Lilly, Gilead Sciences, GlaxoSmithKline, and Regeneron Pharmaceuticals; and consulting fees or honoraria from AstraZeneca and Eli Lilly. Dr. Hilliard has received honoraria for serving on the Speakers Bureau of Abiomed. Dr. de Lemos has received honoraria from AstraZeneca; and consultant fees from the Sanofi and Daiichi-Sankyo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 1, 2015.
- Revision received July 21, 2015.
- Accepted August 14, 2015.
- 2015 American College of Cardiology Foundation