Myocardial infarction (MI) patients who had previously undergone coronary artery bypass graft surgery (CABG) may be less likely than other MI patients, including those with prior percutaneous coronary intervention (PCI), to be treated within the 90-minute recommended timeframe to restore blood flow to the heart, according to a study published Dec. 28 in JACC: Cardiovascular Interventions. 

Using data from ACC’s CathPCI Registry linked with ACC’s ACTION Registry-GWTG, researchers examined records of 15,628 MI patients. Of that group, 6 percent had a history of previous CABG, 19 percent had previous PCI, and 75 percent had no prior history of procedures.

Results showed that 76 percent of patients with prior CABG were treated within the recommended 90-minute timeframe compared to 88.5 percent of patients with prior PCI and 88 percent of patients with no previous interventions. Overall, 88.3 percent of patients in the prior surgery group had successful procedures compared with 93.4 percent of patients who had a prior PCI and 94.4 percent of patients with no prior interventions. After adjusting for clinical and procedural differences, the study found no significant differences in in-hospital mortality, major adverse events, and major bleeding among the three groups.

Luis Gruberg, MD, FACC, the study’s lead author explains that, “patients with a history of prior CABG have more complex anatomy and more comorbidities, and therefore have a more prolonged treatment time compared to the other groups in the study. Nonetheless, every effort should be made to improve timeliness in patients with a history of previous CABG,” he adds.

In an accompanying editorial, John S. Douglas Jr., MD, FACC, says the delay in treatment time for prior bypass graft patients has important implications for salvaging the heart muscle. “Increased awareness that ‘time is muscle’ may lead to more timely performance” for these difficult patients, he adds.

Keywords: Comorbidity, Coronary Artery Bypass, Hospital Mortality, Myocardial Infarction, Myocardium, Percutaneous Coronary Intervention, Registries

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