Author + information
Patients presenting with non ST segment elevation acute coronary syndrome (NSTEMI-ACS) have higher morbidity and mortality, if treated only conservatively in comparison to invasive revascularization strategy.
Coronary artery bypass graft (CABG) surgery is a commonly performed procedure. Nearly 2/3rd of patients suffer graft occlusion within 10 years of surgery (up to 10% grafts lost within first 12 months). More than 1 in 10 hospital admissions with chest pain in UK have prior CABG.
Patients with previous CABG, presenting with NSTEMI-ACS is a high risk group, comparable to those presenting with NSTEMI-ACS, without previous CABG. These patients are most likely to have moderate to severe diffuse disease, and due to complex coronary anatomy, it is not always easy to find out the culprit lesion, when they present with NSTEMI-ACS.
In present work, we wanted to evaluate, whether the patients with previous CABG, presenting with NSTEMI-ACS are offered similar opportunity of invasive treatment in comparison to those without previous CABG.
We analyzed catheter laboratory data from University Hospital of Wales (UHW), Cardiff, UK from 2008 to 2011, evaluating number of patients presenting with non ST segment elevation acute coronary syndrome (NSTEMI-ACS) with or without CABG and their management plan after coronary angiogram.
Total of 5054 patients presenting with NSTEMI-ACS underwent coronary angiography (266 patients with CABG, 5.3% of total).
In patients without CABG, presenting with NSTEMI-ACS, 27.4% were treated medically, 51.5% were treated with percutaneous coronary intervention (PCI), 15.6% were refereed for CABG, 0.7% were refereed for CABG + valve replacement and 4.8% required further investigations (67.8% of patients were referred for some form of revascularization). Whereas in patients with previous CABG, who presented with NSTEMI-ACS, 46.5 % were treated medically, 41% were treated with PCI, 3.4% were refereed for re-do CABG, 0.4% were refereed for CABG + valve replacement and 8.7% required further investigation.
Despite of being intermediate - high risk, patients with previous CABG presenting with NSTEMI-ACS, are significantly less likely to be treated with invasive management strategy (67.8 % vs. 44.8%), in comparison to those presenting with NSTEMI-ACS without previous CABG. Prognostic impact of the different management strategy in this cohort of patients remains unknown.
- 2013 American College of Cardiology Foundation