COMPARISON OF RESULTS OF CORONARY ANGIOPLASTY DURING ACUTE MYOCARDIAL-INFARCTION WITH AND WITHOUT PREVIOUS CORONARY-BYPASS SURGERY

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.