Patients with prior coronary artery bypass grafting have a poor outcome after myocardial infarction: an analysis of the VALsartan in acute myocardial iNfarcTion trial (VALIANT)

Berry, C. , Pieper, K., White, H., Solomon, S., Van de Werf, F., Velazquez, E., Maggioni, A., Califf, R., Pfeffer, M. and McMurray, J. (2009) Patients with prior coronary artery bypass grafting have a poor outcome after myocardial infarction: an analysis of the VALsartan in acute myocardial iNfarcTion trial (VALIANT). European Heart Journal, 30(12), pp. 1450-1456. (doi:10.1093/eurheartj/ehp102)

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Publisher's URL: http://eurheartj.oxfordjournals.org/content/30/12/1450

Abstract

The number of patients presenting with an acute myocardial infarction (MI) and prior coronary artery bypass grafting (CABG) is increasing. We compared the baseline characteristics, treatment, and clinical outcomes of patients with and without prior CABG in the VALIANT trial. Of the 14 703 patients with heart failure (HF), left ventricular systolic dysfunction, or both enrolled in VALIANT, 1026 (7%) had prior CABG. Prior CABG patients were older [mean age (SD): 67 (10) vs. 65 (12) years; P less than 0.0001], had more comorbidity, and more frequent non-Q wave MI (66 vs. 30%; P less than 0.0001). At hospital presentation, prior CABG patients received less aspirin (82 vs. 90%; P less than 0.0001) and thrombolysis (21 vs. 36%; P less than 0.0001), but had a similar rate of primary percutaneous coronary intervention (14 vs. 15%; P = 0.2). Prior CABG patients were more likely to experience the composite outcome of cardiovascular death, MI, HF, resuscitated cardiac arrest, or stroke; 3 year Kaplan-Meier rate, 64 vs. 39% (adjusted hazard ratio 1.29, 95% confidence interval 1.17-1.43; P less than 0.0001). Patients with prior CABG had a worse clinical profile and experienced more fatal and non-fatal outcomes. Greater recognition is necessary for these high-risk patients including optimization of evidence-based secondary preventive therapy.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McMurray, Professor John and Berry, Professor Colin
Authors: Berry, C., Pieper, K., White, H., Solomon, S., Van de Werf, F., Velazquez, E., Maggioni, A., Califf, R., Pfeffer, M., and McMurray, J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences
Journal Name:European Heart Journal
ISSN:0195-668X
Published Online:03 April 2009

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