P. Santiago et al., COMPARISON OF RESULTS OF CORONARY ANGIOPLASTY DURING ACUTE MYOCARDIAL-INFARCTION WITH AND WITHOUT PREVIOUS CORONARY-BYPASS SURGERY, The American journal of cardiology, 72(18), 1993, pp. 1348-1351
Six hundred one consecutive patients undergoing reperfusion within 6 h
ours of acute myocardial infarction were studied with regard to impact
of previous coronary artery bypass grafting (CABG) on direct coronary
angioplasty performance and results. Forty-nine patients (8%) had pre
viously undergone CABG, whereas 552 (92%) had not. Direct angioplasty
was used for reperfusion in 35 patients (71%) in the CABG group, and i
n 258 (47%) in the non-CABG group (p < 0.01). No significant differenc
es between these groups were noted with regard to gender, age, infarct
ion site, time to reperfusion or angioplasty success (34 of 35 CABG pa
tients [97%] vs 236 of 258 non-CABG patients [92%]). CABG patients wer
e more likely to have had previous infarction (17 of 35 [49%] vs 35 of
258 [14%] [p < 0.001]), multivessel disease (34 of 35 [97%] vs 127 of
258 [49%] [p < 0.0011) and lower mean ejection fraction (0.36 +/- 0.1
3 vs 0.46 +/- 0.12, p < 0.001). Over a mean follow-up of 151 weeks, 24
patients (69%) in the CABG group were restudied versus 112 (43%) in t
he non-CABG group (p < 0.01). Restenosis occurred in 14 patients (40%)
in the CABG group versus 58 (22%) in the group without previous CABG
(p = 0.04). In the CABG group, restenosis occurred significantly more
often in saphenous vein grafts than in native vessels (12 of 17 [71%]
vs 2 of 11 [18%] [p < 0.021). There was no significant difference in t
he overall performance of repeat angioplasty between the 2 groups. Lik
ewise, the frequency of the individual end points of recurrent myocard
ial infarction, CABG and death were not significantly different betwee
n the 2 groups. There was no significant difference in overall surviva
l by life-table analysis. However, event free survival was significant
ly (p = 0.04) better in patients without previous CABG.