Acute coronary syndrome in patients with prior coronary artery bypass surgery: observations from a 20-year registry in a middle-eastern country.

OBJECTIVES: Clinical characteristics and trends in the outcome of acute coronary syndrome (ACS) in patients with prior coronary artery bypass graft surgery (CABG) are unclear. The aim of this study was to evaluate clinical characteristics, in-hospital treatment, and outcomes in patients presented with ACS with or without a history of prior CABG over 2 decades. METHODS: Data were derived from hospital-based study for collected data from 1991 through 2010 of patients hospitalized with ACS in Doha, Qatar. Data were analyzed according to their history of prior CABG. Baseline clinical characteristics, in-hospital treatment, and outcome were compared. RESULTS: A total 16,750 consecutive patients with ACS were studied, of which 693 (4.1%) had prior CABG. Patients with prior CABG were older (mean 60.5±11 vs. 53±12 years; P = 0.001), more likely to be females and have more cardiovascular risk factors than the non-CABG group. Prior CABG patients had larger infarct size, were less likely to receive reperfusion therapy, early invasive therapy and more likely to receive evidence-based therapies when compared to non-CABG patients. In-hospital mortality and stroke rates were comparable between the 2 groups. Over 2 decades, there was reduction in the in-hospital mortality rates and stroke rates in both groups (CABG, death; 13.2% to 4%, stroke; 1.9% to 0.0%, non-CABG, death; 10% to 3.2%, stroke 1.0% to 0.1%; all, p = 0.001). CONCLUSION: Significant reduction in-hospital morbidity and mortality among ACS patients with prior CABG over a 20-year period

The 20-year trend of medications prescribed during admission in patient with acute coronary syndrome.

<p>Data are expressed in numbers (%) of patients. Same abbreviations mentioned in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0040571#pone-0040571-t002" target="_blank">table 2</a>.</p

The predictors of in-hospital mortality in patients with prior coronary artery bypass surgery who presented with acute coronary syndrome.

<p>CABG  =  coronary artery bypass graft; ACS  =  acute coronary syndrome; ACE  =  angiotensin-converting enzyme; ARB  =  angiotensin receptor blocker; LMWH  =  low molecular weight heparin.</p

Multivariate analysis of predictors of in-hospital mortality in patients presented with acute coronary syndromes.

<p>CABG  =  coronary artery bypass graft; LMWH  =  low molecular weight heparin; ACE =  angiotension converting enzyme, ARB  =  angiotensin receptor blocker; CI  =  confident interval.</p

The 20 years trend of mortality in 16,750 patients with acute coronary syndrome with or without history of prior coronary artery bypass surgery.

<p>CABG  =  coronary artery bypass graft; ACS  =  acute coronary syndrome.</p

Medication received before, during admission and at discharge in acute coronary syndrome patients with or without prior coronary artery bypass surgery.

<p>Data are expressed in numbers (%) of patients.CABG  =  coronary artery bypass graft; HMG-CoA  =  hydroxy methyl glutaryl-coenzyme A; GP  =  glycoprotein; LMWH  =  low molecular weight heparin; CCB  =  calcium channel blockers; ACE = angiotension converting enzyme inhibitor, ARB = angiotensin receptor blocker.</p

Acute coronary syndrome patients’ baseline demographics, clinical characteristics and outcomes according to their history of prior coronary artery bypass surgery.

<p>Data are expressed in numbers (%) of patients unless otherwise indicated.</p>*<p>Systolic blood pressure >140 mm Hg, diastolic blood pressure >90 mm Hg, or current antihypertensive treatment.</p>†<p>Patient had been informed of the diagnosis by a physician before admission and for type 1 or 2 diabetes.</p>††<p>Total cholesterol >5.2 mmol/L or current use of lipid-lowering agent.</p>‡<p>Of patients eligible for thrombolysis (ST-elevation myocardial infarction (previously known Q wave MI) or new or presumed left bundle branch block).CABG  = coronary artery bypass graft; CCU = coronary care unit; MI = myocardial infarction; STEMI = ST elevation myocardial infarction; NSTEMI = non ST elevation myocardial infarction.</p