Abstract 19050: Does Type of Culprit Lesion Matter in Patients with Acute Coronary Syndrome and Prior Coronary Artery Bypass Graft Surgery Undergoing Percutaneous Coronary Intervention?

Background: Acute coronary syndrome (ACS) in patients with prior coronary artery bypass graft (CABG) surgery may be due to graft failure or progression of native coronary artery disease. We studied whether the culprit lesion (graft vs. native) is associated with differences in hospital and long-term outcomes. Methods: We included ACS patients with prior CABG who underwent percutaneous coronary intervention (PCI) of >=1 lesion at the Academic Medical Center - University of Amsterdam between 1998 and 2008. The primary outcome was 5-year mortality and the secondary outcome was a composite of in-hospital death, myocardial infarction, need-for-revascularization and stroke. Kaplan-Meier estimates were used to compare 5-year mortality between patients with graft vs. native culprit lesions. Predictors for 5-year mortality were identified using multivariable Cox proportional hazards modeling with backwards variable selection. Logistic regression was used to assess predictors for in-hospital outcomes. Results: Overall, 270 patients were included, of which 146 (54.1%) had a graft culprit lesion. Mean age was 70 (SD=9.5yrs), 21.9% were women. Multi-vessel PCI was performed in 50 (18.5%) patients. 5-year mortality was similar following graft versus native culprit lesion PCI (41.3% vs. 36.4%, HR:1.16, 95%-CI:0.73-1.84, p=0.52). In-hospital death, MI, need-for-revascularization and/or stroke was also comparable (16.4% vs. 13.7%, HR:1.24 (95%-CI:0.63-2.43), p=0.53). Similar results were seen after adjusting for important covariates. Older age, lack of prior aspirin use, and cardiogenic shock were independently associated with worse clinical outcomes. Conclusion: Type of culprit lesion (either native or graft) in patients presenting with ACS and prior CABG surgery was not associated with in-hospital or long-term clinical outcomes. Larger studies to validate our findings are warranted.