Elsevier

The American Journal of Cardiology

Volume 135, 15 November 2020, Pages 9-16
The American Journal of Cardiology

Impact of Prior Coronary Artery Bypass Grafting in Patients ≥75 Years Old Presenting With Acute Myocardial Infarction (From the National Readmission Database)

https://doi.org/10.1016/j.amjcard.2020.08.036Get rights and content

Patients ≥75 years old presenting with acute myocardial infarction (AMI) have complex coronary anatomy in part due to prior coronary artery bypass grafting (CABG), percutaneous coronary interventions (PCI), calcific and valvular disease. Using the National Readmission Database from January 2016 to November 2017, we identified hospital admissions for acute myocardial infarction in patients ≥75 years old and divided them based on a history of CABG. We evaluated in-hospital outcomes, 30-day mortality, 30-day readmission and predictors of PCI in cohorts. Out of a total of 296,062 patients ≥75 years old presenting with an AMI, 42,147 (14%) had history of previous CABG. Most presented with a non-ST segment elevation myocardial infarction, and those with previous CABG had higher burden of co-morbidities and were more commonly man. The in-hospital mortality was significantly lower in those with previous CABG (6.7% vs 8.8%, adjusted odds ratio, 0.88, 95% confidence interval, 0.82 to 0.94). Medical therapy was more common in those with previous CABG and 30-day readmission rates were seen more frequently in those with prior CABG. Predictors of not undergoing PCI included previous PCI, female, older ager groups, heart failure, dementia, malignancy, and higher number of co-morbidities. In conclusion, in patients ≥75 years old with AMI the presence of prior CABG was associated with lower odds of in-hospital and 30-day mortality, as well as lower complications rates, and a decreased use of invasive strategies (PCI, CABG, and MCS). However, 30-day MACE readmission was higher in those with previous CABG.

Section snippets

Background

Acute cardiovascular disease is a leading cause of morbidity and mortality in adults of any age, however elderly patients are at a higher risk for adverse outcomes, including mortality and rehospitalizations.1 With improvement in revascularization options for both stable and acute coronary disease and resultant increase life expectancy, elderly patients presenting with acute myocardial infarction (AMI) have complex coronary anatomy in part due to previous coronary artery bypass grafting (CABG),

Methods

The study cohort was derived from the National Readmission Database (NRD), a publicly available database of all-payer hospital inpatient stays developed by the Agency for Healthcare Research and Quality as part of the Healthcare Cost and Utilization Project. The NRD was constructed from 22 States with reliable and verified patient linkage numbers in the State Inpatient Databases that could be used to track the patient across hospitals within a State, while adhering to strict privacy guidelines.

Results

A total of 296,062 patients ≥75 years old presented with an acute myocardial infarction, out of which 14% (N = 42,147) had history of previous CABG. The majority presented with non-ST segment elevation myocardial infarction (NSTEMI) (79%), with an even higher frequency in those with previous CABG (89.2% vs 77.7%, p <0.001). In patients presenting with ST segment elevation myocardial infarction (STEMI) (21%), inferior wall STEMI was most commonly seen (42.9%), followed by anterior wall MI

Discussion

Using real-world data, we evaluated a large cohort of patients ≥ 75 years old who presented with AMI and provided new insights about the relationship of previous CABG and in-hospital outcomes (Figure 6). The key findings of our study are (1) despite lower rates revascularization, patients with previous CABG had significantly lower in-hospital mortality. (2) Subgroup analysis demonstrated lower mortality rates in those older than 80 years old. (3) Those with previous CABG had lower rates of

Author Contributions

Alejandro Lemor: Writing - Original Draft, Conceptualization, Formal analysis; Gabriel A. Hernandez: Conceptualization, Methodology; Mir B Basir: Resources, Writing - Original Draft; Sati Patel: Validation, Investigation; Pedro A. Villablanca: Methodology, Writing - Review & Editing; Khaldoon Alaswad: Resources, Supervision, Project administration; William O'Neill: Writing - Review & Editing, Supervision.

Disclosures

Dr. Basir has the following disclosures: Abbott Vascular, Abiomed, Chiesi, Cardiovascular Systems, and Zoll. Dr O'Neill has the following disclosures: Abiomed and Abbott. The rest of the authors have nothing to disclose.

REFERENCES (19)

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Cited by (1)

  • Cardiac Catheterizations in Patients With Acute Coronary Syndrome and Prior Coronary Bypass Surgery: Impact of Native vs Graft vs Absent Culprit Lesions on Clinical Outcomes and Treatment Strategy

    2022, Cardiovascular Revascularization Medicine
    Citation Excerpt :

    Overall, 81.2 % of patients were treated with PCI, 0.7 % underwent re-CABG, and 18.0 % was treated medically, illustrating that 4 out of every 5 patients was invasively treated in the present study. Conversely, in a large registry with 42,147 CABG patients presenting with myocardial infarction, PCI was only performed in 30.0 %, while 69.2 % was treated with medication only [15]. This large numerical difference might be explained by the fact that patients in our study were 9 years younger and treated in a tertiary care high-volume PCI center with a broad experience in treating grafts percutaneously [16].

No funding support was obtained for this original research.

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