Assessing Safety of CABG in the Era Post Primary PCI, an Outcome Analysis of STEMI Population

Abstract

Background: Primary PCI (PPCI) has replaced thrombolysis as the treatment of choice for STEMI. The effect of this change on outcomes of patients referred for subsequent CABG is unknown. Methods: All STEMI patients having thrombolysis or PPCI between 2000 and 2010 were identified. Of these, patients subsequently referred for isolated first time CABG form the cohort for this study. Results: 83 of 2476 (3.4%) patients from the PPCI cohort (median follow-up [FU] 3 years [range 6 m - 7.8 y]) and 49 of 528 (9.2%) from the thrombolysis cohort (median FU 9 y [range 1.5 - 10 y] were referred for subsequent CABG. In this referred group, initial reperfusion success (as defined) was: PPCI = 86%, lysis = 84%, p = 0.69. Surgical waiters with prior PPCI had less post infarct angina (1.2% vs. 25%, p /span> 0.01) and late re-infarction (6% vs. 20%, p = 0.034) prior to surgery. Timing of CABG was: st1:chmetcnv tcsc="0" numbertype="1" negative="False" hasspace="True" sourcevalue="6" unitname="m" w:st="on">6 m (PPCI 82%, lysis 73%), 6 m-1 y (PPCI 8.4%, lysis: 9%), >1 y (PPCI 9.6%, lysis 18%).Other than an increased prevalence of diabetes in the thrombolysis group, there were no differences in demographic details or risk profile. There were no post-operative deaths, MIs or CVAs. There were no significant differences in post-op AF (28% vs. 22% p = 0.5), respiratory failure (8% vs. 18%, p = 0.08), renal failure (5% vs. 6%, p = 0.5) or re-openings (0% vs. 6%, p = 0.8). Mortality at 3 years was 2.4% in the PPCI cohort and 4% in the thrombolysis cohort. Overall mortality during follow-up for the PPCI group was 3.6% (n = 3) (median FU 3 years), and for the lysis group was 24.5% (n = 12) (median FU 9 years). Conclusions: In patients awaiting CABG after STEMI, PPCI reduces the risk of post-infarct angina and re-infarction prior to surgery, but early surgical results were equally favorable in both groups. Additional follow-up is needed in the PPCI cohort to determine whether there are any significantly different longer-term outcomes.