Temporal Trends Analysis (2000-2016) of Patients with Prior Coronary Artery Bypass Graft Surgery who are Admitted with an Acute Coronary Syndrome - The 65th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 24-25 April 2018

Ilan Marcuschamer Cardiology Department, Beilinson-Rabin Hospital, Petah Tikwah, Israel Zaza Iakobishvili Cardiology Department, Beilinson-Rabin Hospital, Petah Tikwah, Israel Abid Assali Cardiology Department, Beilinson-Rabin Hospital, Petah Tikwah, Israel Hana Vaknin-Assa Cardiology Department, Beilinson-Rabin Hospital, Petah Tikwah, Israel Roy Beigel Cardiology Department, Sheba Academic Medical Center Hospital - Tel Hashomer, Ramat Gan, Israel Tal Cohen Cardiology Department, Sheba Academic Medical Center Hospital - Tel Hashomer, Ramat Gan, Israel Ilan Goldenberg Cardiology Department, Sheba Academic Medical Center Hospital - Tel Hashomer, Ramat Gan, Israel Ran Kornowski Cardiology Department, Beilinson-Rabin Hospital, Petah Tikwah, Israel Alon Eisen Cardiology Department, Beilinson-Rabin Hospital, Petah Tikwah, Israel

Background: Patients with prior coronary artery bypass graft surgery (CABG) are at increased risk for recurrent cardiovascular ischemic events. During the last decade, advances in pharmacological and invasive management have improved prognosis of patients with ACS, yet it is not known whether similar trends exist in patients with prior CABG, a particularly high-risk group.

Aim: To examine temporal trends in the prevalence, characteristics, treatment, and clinical outcomes of patients with prior CABG who are admitted with ACS.

Methods: Time-dependent analysis of patients with or without prior CABG admitted with ACS who were enrolled in the biennial ACS Israeli Surveys (ACSIS) between 2000 and 2016. Surveys were divided into early (2000-2008) and late (2010-2016) time-periods. Clinical outcomes included 30d MACE (death, myocardial infarction, stroke, unstable angina, stent thrombosis, urgent revascularization) and 1-year mortality.

Results: Among 15,152 patients with ACS, 1504 (9.9%) had a prior CABG. Compared to patients without prior CABG, patients with prior CABG were older (69 vs. 63 years), had more prior myocardial infarction (74% vs. 26%), heart failure (23% vs. 6%), and presented more with NSTE-ACS (82% vs. 51%). Compared with the early period, utilization of dual antiplatelet therapy, statins and percutaneous coronary intervention in the late period had significantly increased in both, patients with or without prior CABG (p<0.001 for each). Between the early and late periods, the rate of 30d MACE has decreased in patients with and without prior CABG (19.1% vs. 12.3%, and 17.5% vs. 9.3%, respectively; p<0.001 for each). However, 1-year mortality has decreased in patients without prior CABG (10.4% vs. 7.7%, p<0.001) but not in patients with prior CABG (12.7% vs. 13.0%, p=NS)(Figure).

Conclusions: Despite an improvement in the management and short-term prognosis of ACS patients in the last decade, 1-year mortality of patients with prior CABG admitted with an ACS remained unchanged.

Figure: Kaplan-Meier curves for 1-year mortality by time-period (early vs. late) in patients without (a) or with (b) prior CABG.

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