TCT CONNECT-27 Impact of Prior Coronary Artery Bypass in Elderly Patients Presenting With Acute Myocardial Infarction

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Conference Proceeding

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Publication Title

Journal of the American College of Cardiology


Background: Elderly patients presenting with acute myocardial infarction (AMI) have complex coronary anatomy in part due to prior coronary artery bypass (CABG) surgery, percutaneous coronary interventions (PCI), and calcific and valvular disease.

Methods: Using the National Readmission Database from January 2016 to November 2017, we identified hospital admissions for AMI in patients ≥75 years of age and divided them based on a history of CABG. We evaluated in-hospital outcomes, 30-day mortality, 30-day readmission, and predictors of PCI among cohorts.

Results: Of a total of 296,062 patients ≥75 years presenting with an AMI, 42,147 (14%) had history of prior CABG. The majority presented with a non–ST-segment elevation myocardial infarction (NSTEMI), and those with prior CABG had higher burden of comorbidities and were more commonly male. The in-hospital mortality rate was significantly lower in those with prior CABG (6.7% vs. 8.8%; aOR: 0.88; 95% confidence interval [CI]: 0.82 to 0.94). Medical therapy was more common in those with prior CABG and 30-day readmission rates were seen more frequently in those with prior CABG. Predictors of not undergoing PCI included prior PCI, female gender, older ager groups, heart failure, dementia, malignancy, and higher number of comorbidities.

Conclusion: In elderly patients 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 major adverse cardiac event readmission was higher in those with prior CABG.





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