The Open Cardiovascular Medicine Journal




ISSN: 1874-1924 ― Volume 13, 2019

Clinical Characteristics and Outcomes of Patients with Acute Coronary Syndrome and Prior Coronary Artery Bypass Grafting in a Large Middle Eastern Cohort



Muath Alanbaei1, *, Alawi A Alsheikh-Ali2, Tareq Aleinati3, Mohammad Zubaid1, Mustafa Ridha4, Fahad Alenezi4, Wael Al-Mahmeed5, Kadhim Sulaiman6, Jawad Al-Lawati7, Haitham Amin8, Jassim Al Suwaidi9, Ahmed Al-Motarreb10
1 Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait
2 Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates and Tufts Clinical and Translational Science Institute, Tufts Medical Center, Boston, MA, USA
3 Department of Cardiac Surgery, Chest Diseases Hospital, Ministry of Health, Kuwait
4 Division of Cardiology, Department of Medicine, Adan Hospital, Ministry of Health, Kuwait
5 Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
6 Royal Hospital, Muscat, Oman
7 Department of Non-communicable Diseases Control, Ministry of Health, Muscat, Oman
8 Mohammed Bin Khalifa Cardiac Centre, Manama, Bahrain
9 Hamad General Hospital and Hamad Medical Corporation, Doha, Qatar
10 Department of Medicine, Faculty of Medicine, Sana'a University, Sana'a, Yemen

Abstract

Background:

Acute Coronary Syndrome (ACS) can occur in patients with prior coronary artery bypass grafting (CABG). In the Gulf Registry of acute coronary events (Gulf RACE), we identified the clinical characteristics and in-hospital outcomes of these patients.

Methods:

Clinical characteristics and in-hospital outcomes for 461 ACS patients with prior CABG are compared to 7715 ACS patients without prior CABG enrolled from 64 hospitals in 6 Gulf countries over a 6-month period.

Results:

The overall incidence of ACS with prior CABG was 5.6% out of 8176 patients. The ACS with prior CABG were older (63 vs 55 years, P<0.0001), had more history of diabetes (62.3 vs 37.6%, P <0.0001), dyslipidemia (70.3 vs 29.5%, P<0.0001), and hypertension (75.7 vs 47.8%, P<0.0001) compared with the non-CABG group. They presented more frequently with dyspnea (14.8 vs 9.5%, P<0.0005), non-ST segment elevation myocardial infarction (41.4 vs 31.6%, P<0.0001) and echocardiographic evidence of left ventricular dysfunction (49.4 vs 29.8%, P<0.0001) than ACS without prior CABG. They had a complicated in-hospital course with more recurrent ischemia (13.9 vs 9.3%, P=0.0011), heart failure (24.1 vs 15.7%), and stroke (2.2 vs 0.6%) compared with those without CABG. The in-hospital mortality rate was 5.6% in the CABG group compared with 3.5% in the ACS without prior CABG group. After adjusting for confounders, prior CABG was independently associated with recurrent ischemia and shock, more in patients presenting with ST elevation than non-ST elevation ACS.

Conclusions:

Patients with ACS and prior CABG are a high-risk group with poor outcomes irrespective of their older age and comorbidities. They should be identified and treated differently to improve their outcomes.

Keywords: Acute Coronary Syndrome, Angioplasty, Comorbidity, Coronary Artery Bypass Grafting, Risk factors, Stroke..


Article Information


Identifiers and Pagination:

Year: 2011
Volume: 5
First Page: 196
Last Page: 202
Publisher Id: TOCMJ-5-196
DOI: 10.2174/1874192401105010196

Article History:

Received Date: 30/6/2011
Revision Received Date: 22/7/2011
Acceptance Date: 25/7/2011
Electronic publication date: 30/8/2011
Collection year: 2011

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© Alanbaei et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.


* Address correspondence to this author at the Faculty of Medicine – Kuwait University, Medicine Department – Forth floor P.O. Box 24923 - Safat 13110 Kuwait; Tel: (965) 24986353; Fax: (965) 25318454; E-mail: muath.alanbaei@hsc.edu.kw



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