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Incidence and Characteristics of ST-Elevation Myocardial Infarction in Patients With Previous Coronary Artery Bypass Grafting: A Single-Center Experience

Year: 2025

Type: article

Abstract: INTRODUCTION: ST-elevation myocardial infarction (STEMI) in patients with prior coronary artery bypass graft (CABG) represents a complex entity, with limited characterization. We sought to analyze the clinical and angiographic characteristics of post-CABG patients presenting with STEMI at a single, large referral center in the Southeastern United States. METHODS: We reviewed the STEMI alert database at the Medical University of South Carolina (MUSC). We included all patients with STEMI, as defined by the Fourth Universal Definition of Myocardial Infarction, who presented between June 2009 and December 2022. From this, we then identified those with prior CABG and analyzed their clinical and angiographic features. We compared these characteristics with patients without prior CABG. Finally, we analyzed outcomes including in-hospital complications, length of stay (LOS), in-hospital mortality, and one-year mortality. RESULTS: Of 836 true STEMIs, 35 (4.2%) patients had a previous CABG. The mean (standard deviation (SD)) age was 67 (12) years, and most were male patients with multiple comorbidities. Thirty-one (88.6%) underwent percutaneous coronary intervention (PCI), of which 14 (45.2%) were due to acute graft occlusion. The most common graft involved was the saphenous vein graft (SVG), seen in 13 (41.9%), while multiple-vessel PCI was the most common in those with native vessel disease, seen in six (19.4%). Most patients achieved thrombolysis in myocardial infarction (TIMI) grade 3 revascularization. In-hospital mortality occurred in two (5.7%) patients, and the mean length of stay was five days. Compared to patients without prior CABG, they were older and had greater comorbidity burdens, but survival did not differ significantly. CONCLUSION: Patients with prior CABG constitute the minority of patients presenting with STEMI. Post-CABG patients were typically older and had a greater comorbidity burden than those without prior CABG. Clinical outcomes after PCI were similar between the two groups, although cautious interpretation is warranted, given the small sample and observational nature of our study.

Source: Cureus

DOI: 10.7759/cureus.86978