PCI underused among NSTEMI patients with prior CABG
Patients presenting with non–ST‐segment–elevation MI (STEMI) who have had prior coronary artery bypass grafting (CABG) experience improved outcomes when managed with percutaneous coronary intervention (PCI), according to new data published in the Journal of the American Heart Association. However, the authors noted, PCI remains underutilized among this patient population.
Researchers examined 287,658 STEMI patients from the Myocardial Infarction National Audit Project, a U.K. database. All patients received care from 2010 to 2017, and 9% had a previous history of CABG.
Patients with prior CABG were significantly older, the team noted. They also presented with acute heart failure symptoms more frequently than patients with no history of CABG. A long list of comorbid conditions—“diabetes mellitus, congestive heart failure, chronic renal failure, hypercholesterolemia, previous MI and PCI, angina, cerebrovascular accident, peripheral vascular disease, hypertension, asthma/chronic obstructive pulmonary disease and severe left ventricular systolic dysfunction”—were also more common among this group.
The authors also found that the percentage of patients who received coronary angiogram (63% versus 69%, PCI (39% versus 45%), and CABG (1% versus 8%) were substantially lower in patients who had a history of CABG.
In‐hospital all‐cause mortality, major bleeding events and major adverse cardiovascular events MACE were similar between the two groups. However,
One big takeaway from the analysis was that PCI appeared to benefit these patients, lowering all-cause mortality by a noticeable margin. Is this a sign that PCI should be turned to more often?
"Percutaneous coronary intervention was underused in patients with NSTEMI who had a prior history of CABG, though it was associated with a mortality benefit compared with conservative management," wrote lead author Ahmad Shoaib, MD, a specialist at Keele University in the U.K., and colleagues.
The team concluded by calling for additional research on the topic of invasive management when it comes to evaluating and caring for NSTEMI patients with a history of CABG.
"Adequately powered randomized controlled clinical trials are needed to confirm these findings," they wrote.
Read the full study here.