Coronary Artery Bypass Graft Surgery in Patients With Acute Coronary Syndromes After Primary Percutaneous Coronary Intervention: A Current Report From the North‐Rhine Westphalia Surgical Myocardial Infarction Registry

Background Coronary artery bypass grafting has remained an important treatment option for acute coronary syndromes, particularly in patients (1) with ongoing ischemia and large areas of jeopardized myocardium, if percutaneous coronary intervention (PCI) cannot be performed; (2) following successful...

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Autores principales:	Matthias Thielmann, Daniel Wendt, Ingo Slottosch, Henryk Welp, Wolfgang Schiller, Konstantinos Tsagakis, Bastian Schmack, Alexander Weymann, Sven Martens, Markus Neuhäuser, Thorsten Wahlers, Yeong‐Hoon Choi, Arjang Ruhparwar, Oliver‐J. Liakopoulos
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	acute coronary syndrome coronary artery bypass grafting outcomes percutaneous coronary intervention registry Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/887543836ea64944ac0c7711ff6eb4ff
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spelling	oai:doaj.org-article:887543836ea64944ac0c7711ff6eb4ff2021-11-23T11:36:35ZCoronary Artery Bypass Graft Surgery in Patients With Acute Coronary Syndromes After Primary Percutaneous Coronary Intervention: A Current Report From the North‐Rhine Westphalia Surgical Myocardial Infarction Registry10.1161/JAHA.121.0211822047-9980https://doaj.org/article/887543836ea64944ac0c7711ff6eb4ff2021-09-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.121.021182https://doaj.org/toc/2047-9980Background Coronary artery bypass grafting has remained an important treatment option for acute coronary syndromes, particularly in patients (1) with ongoing ischemia and large areas of jeopardized myocardium, if percutaneous coronary intervention (PCI) cannot be performed; (2) following successful PCI of the culprit lesion with further indication for coronary artery bypass grafting; and (3) where PCI is incomplete, not sufficient, or failed. Methods and Results We aimed to analyze coronary artery bypass grafting outcome following prior PCI in acute coronary syndromes from the North‐Rhine‐Westphalia surgical myocardial infarction registry comprising 2616 patients. Primary end points were in‐hospital all‐cause mortality and major adverse cardio‐cerebral event. Patients were 68±11 years of age, had 3‐vessel and left main‐stem disease in 80.4% and 45.3%, presenting a logistic EuroSCORE of 15.1% in unstable angina, 20.3% in non–ST‐segment–elevation myocardial infarction, and 23.5% in ST‐segment–elevation myocardial infarction. A history of PCI was present in 36.2% and PCI was performed within 24 hours before surgery in 5.2% in unstable angina, 5.9% in non–ST‐segment–elevation myocardial infarction, and 16.1% in ST‐segment–elevation myocardial infarction. PCI failed in 5.3% in unstable angina, 6.8% in non–ST‐segment–elevation myocardial infarction and 17.2% in ST‐segment–elevation myocardial infarction, and 28.8% of patients presented with cardiogenic shock. In‐hospital mortality without PCI was 7.4%, but increased to 8.7% with prior PCI >24 hours, 14.5% with prior PCI <24 hours, and 14.1% with failed PCI (P<0.003). The in‐hospital major adverse cardio‐cerebral event rate was 16.4% without PCI, but 17.4% with prior PCI >24 hours, 25.6% with prior PCI <24 hours, and 41.3% with failed PCI (P=0.014). Multivariable logistic regression analysis showed prior PCI (P=0.039), as well as failed PCI (P=0.001) to be predictors for in‐hospital all‐cause mortality and major adverse cardio‐cerebral event. Conclusions In the current PCI era, immediately prior or failed PCI before coronary artery bypass grafting in acute coronary syndromes is associated with high perioperative risk, cardiogenic shock, and increased morbidity and mortality.Matthias ThielmannDaniel WendtIngo SlottoschHenryk WelpWolfgang SchillerKonstantinos TsagakisBastian SchmackAlexander WeymannSven MartensMarkus NeuhäuserThorsten WahlersYeong‐Hoon ChoiArjang RuhparwarOliver‐J. LiakopoulosWileyarticleacute coronary syndromecoronary artery bypass graftingoutcomespercutaneous coronary interventionregistryDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 18 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	acute coronary syndrome coronary artery bypass grafting outcomes percutaneous coronary intervention registry Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	acute coronary syndrome coronary artery bypass grafting outcomes percutaneous coronary intervention registry Diseases of the circulatory (Cardiovascular) system RC666-701 Matthias Thielmann Daniel Wendt Ingo Slottosch Henryk Welp Wolfgang Schiller Konstantinos Tsagakis Bastian Schmack Alexander Weymann Sven Martens Markus Neuhäuser Thorsten Wahlers Yeong‐Hoon Choi Arjang Ruhparwar Oliver‐J. Liakopoulos Coronary Artery Bypass Graft Surgery in Patients With Acute Coronary Syndromes After Primary Percutaneous Coronary Intervention: A Current Report From the North‐Rhine Westphalia Surgical Myocardial Infarction Registry
description	Background Coronary artery bypass grafting has remained an important treatment option for acute coronary syndromes, particularly in patients (1) with ongoing ischemia and large areas of jeopardized myocardium, if percutaneous coronary intervention (PCI) cannot be performed; (2) following successful PCI of the culprit lesion with further indication for coronary artery bypass grafting; and (3) where PCI is incomplete, not sufficient, or failed. Methods and Results We aimed to analyze coronary artery bypass grafting outcome following prior PCI in acute coronary syndromes from the North‐Rhine‐Westphalia surgical myocardial infarction registry comprising 2616 patients. Primary end points were in‐hospital all‐cause mortality and major adverse cardio‐cerebral event. Patients were 68±11 years of age, had 3‐vessel and left main‐stem disease in 80.4% and 45.3%, presenting a logistic EuroSCORE of 15.1% in unstable angina, 20.3% in non–ST‐segment–elevation myocardial infarction, and 23.5% in ST‐segment–elevation myocardial infarction. A history of PCI was present in 36.2% and PCI was performed within 24 hours before surgery in 5.2% in unstable angina, 5.9% in non–ST‐segment–elevation myocardial infarction, and 16.1% in ST‐segment–elevation myocardial infarction. PCI failed in 5.3% in unstable angina, 6.8% in non–ST‐segment–elevation myocardial infarction and 17.2% in ST‐segment–elevation myocardial infarction, and 28.8% of patients presented with cardiogenic shock. In‐hospital mortality without PCI was 7.4%, but increased to 8.7% with prior PCI >24 hours, 14.5% with prior PCI <24 hours, and 14.1% with failed PCI (P<0.003). The in‐hospital major adverse cardio‐cerebral event rate was 16.4% without PCI, but 17.4% with prior PCI >24 hours, 25.6% with prior PCI <24 hours, and 41.3% with failed PCI (P=0.014). Multivariable logistic regression analysis showed prior PCI (P=0.039), as well as failed PCI (P=0.001) to be predictors for in‐hospital all‐cause mortality and major adverse cardio‐cerebral event. Conclusions In the current PCI era, immediately prior or failed PCI before coronary artery bypass grafting in acute coronary syndromes is associated with high perioperative risk, cardiogenic shock, and increased morbidity and mortality.
format	article
author	Matthias Thielmann Daniel Wendt Ingo Slottosch Henryk Welp Wolfgang Schiller Konstantinos Tsagakis Bastian Schmack Alexander Weymann Sven Martens Markus Neuhäuser Thorsten Wahlers Yeong‐Hoon Choi Arjang Ruhparwar Oliver‐J. Liakopoulos
author_facet	Matthias Thielmann Daniel Wendt Ingo Slottosch Henryk Welp Wolfgang Schiller Konstantinos Tsagakis Bastian Schmack Alexander Weymann Sven Martens Markus Neuhäuser Thorsten Wahlers Yeong‐Hoon Choi Arjang Ruhparwar Oliver‐J. Liakopoulos
author_sort	Matthias Thielmann
title	Coronary Artery Bypass Graft Surgery in Patients With Acute Coronary Syndromes After Primary Percutaneous Coronary Intervention: A Current Report From the North‐Rhine Westphalia Surgical Myocardial Infarction Registry
title_short	Coronary Artery Bypass Graft Surgery in Patients With Acute Coronary Syndromes After Primary Percutaneous Coronary Intervention: A Current Report From the North‐Rhine Westphalia Surgical Myocardial Infarction Registry
title_full	Coronary Artery Bypass Graft Surgery in Patients With Acute Coronary Syndromes After Primary Percutaneous Coronary Intervention: A Current Report From the North‐Rhine Westphalia Surgical Myocardial Infarction Registry
title_fullStr	Coronary Artery Bypass Graft Surgery in Patients With Acute Coronary Syndromes After Primary Percutaneous Coronary Intervention: A Current Report From the North‐Rhine Westphalia Surgical Myocardial Infarction Registry
title_full_unstemmed	Coronary Artery Bypass Graft Surgery in Patients With Acute Coronary Syndromes After Primary Percutaneous Coronary Intervention: A Current Report From the North‐Rhine Westphalia Surgical Myocardial Infarction Registry
title_sort	coronary artery bypass graft surgery in patients with acute coronary syndromes after primary percutaneous coronary intervention: a current report from the north‐rhine westphalia surgical myocardial infarction registry
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/887543836ea64944ac0c7711ff6eb4ff
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Coronary Artery Bypass Graft Surgery in Patients With Acute Coronary Syndromes After Primary Percutaneous Coronary Intervention: A Current Report From the North‐Rhine Westphalia Surgical Myocardial Infarction Registry

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