Does Invasive Treatment Increase the Long-term Survival of ST-Elevation Myocardial Infarction Patients with a History of Coronary Artery Bypass Graft Surgery?

Mohsen  Taghavi Shavazi; Seyedmohammad  Saadatagah; Hassan  Aghajani; Hamidreza   Poorhosseini; Mojtaba   Salarifar; Alireza  Amirzadegan; Alimohammd  Hajzeinali; Mohammad   Alidoosti; Reyhaneh  Aghajani; Ebrahim   Neamatipour

doi:10.18502/jthc.v14i3.1429

Mohsen Taghavi Shavazi
Seyedmohammad Saadatagah
Hassan Aghajani
Hamidreza Poorhosseini
Mojtaba Salarifar
Alireza Amirzadegan
Alimohammd Hajzeinali
Mohammad Alidoosti
Reyhaneh Aghajani
Ebrahim Neamatipour

DOI: https://doi.org/10.18502/jthc.v14i3.1429

Keywords: Acute coronary syndrome; ST elevation myocardial infarction; Survival analysis; Thrombolytic therapy; Percutaneous coronary intervention; Coronary artery bypass

Abstract

Background: Although invasive treatments such as primary percutaneous coronary intervention (PPCI) are the treatment of choice in ST-elevation myocardial infarction (STEMI) patients, the survival benefit of this treatment in patients with a history of coronary artery bypass graft (CABG) has yet to be fully evaluated.

Methods: In this historical cohort study, 251 STEMI patients with a history of CABG between 2007 and 2017 were stratified into 3 groups of no reperfusion, thrombolytic, and PPCI based on their treatment strategy. Baseline clinical characteristics, details of the STEMI event, and the course of hospitalization were evaluated for all patients and they were followed up until May 2018 to assess all-cause mortality.

Results: The mean age of the study population was 64.01±9.45 years, and 81.7% of them were male. The median follow-up time was 1304 (IQR_25%-75%: 571–2269) days, the short-term (1 month) mortality rate was 5.97%, and the long-term mortality rate was 15.1%. There was no significant difference between the 3 different strategies in terms of survival. In the fully adjusted multivariate analysis, cardiopulmonary resuscitation (HR: 15.06, 95% CI: 2.25–101.14, P=0.005) was significantly associated with short-term mortality, while diabetes (HR: 5.95, 95% CI: 2.03–17.44, P=0.001), opium abuse (HR: 4.85, 95% CI: 1.45–16.23, P=0.010), and cardiopulmonary resuscitation (HR: 11.73, 95% CI: 3.44–40.28, P=0.001) were significantly associated with long-term mortality.

Conclusion: Our results failed to show the superiority of invasive treatment in terms of survival. Further studies regarding the advantages and disadvantages of invasive treatment in post-CABG patients are required.