Inhospital outcome of acute myocardial infarction in patients with prior coronary artery bypass surgery

Verghese Mathew, Bernard Gersh, Hal Barron, Nathan Every, Alan Tiefenbrunn, Paul Frederick, Judith Malmgren

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Objectives: Our goals were to compare the characteristics of patients with and without prior coronary artery bypass graft (CABG) presenting with acute myocardial infarction (MI) with or without ST elevation/left bundle branch block (LBBB), and to evaluate the effect of ST shift on inhospital mortality. Methods and Results: Using the National Registry of Myocardial Infarction-3 Registry, we identified 112,697 patients with acute MI without exclusion criteria. Of these, 15,936 (14.1%) had prior CABG. Patients with prior CABG had more adverse characteristics and were less likely to have ST elevation/LBBB than patients without prior CABG. The unadjusted mortality for ST elevation/LBBB patients was higher in patients with prior CABG versus without (16.2% vs 14.1%, P = .0001), whereas in patients without ST elevation/LBBB, prior CABG conferred a lower unadjusted mortality versus without (10.1% vs 12.4%, P = .0001). Adjusting for baseline differences, prior CABG was weakly associated with inhospital mortality in ST elevation/LBBB patients (odds ratio [OR], 1.11, 95% CI 1.00-1.23), but not in patients without ST elevation/LBBB (OR 0.99, 95% CI 0.92-1.07). Conclusion: Acute MI patients with prior CABG are more likely to present without ST elevation/LBBB than patients without prior CABG. Prior CABG was weakly associated with inhospital mortality in patients with ST elevation/LBBB, but not in patients without these electrocardiographic findings. This suggests the differences in absolute mortality rates between patients presenting with MI with and without a history of prior CABG are largely caused by differences in baseline characteristics and presentation.

Original languageEnglish (US)
Pages (from-to)463-469
Number of pages7
JournalAmerican Heart Journal
Volume144
Issue number3
DOIs
StatePublished - Sep 2002

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Mathew, V., Gersh, B., Barron, H., Every, N., Tiefenbrunn, A., Frederick, P., & Malmgren, J. (2002). Inhospital outcome of acute myocardial infarction in patients with prior coronary artery bypass surgery. American Heart Journal, 144(3), 463-469. https://doi.org/10.1067/mhj.2002.124349