Angiographic profile and therapeutic approach of prior coronary artery bypass graft patients presenting with acute coronary syndromes

Abstract

Objectives: Patients presenting as acute coronary syndromes (ACS) after coronary artery bypass graft (CABG) surgery are different subset with multiple comorbidities. Reappearance of symptoms could be due to either native vessel, graft disease, or both. The aim of the present study was to evaluate the mode of presentation, angiographic profile, and management strategies followed in them. Methods: One hundred consecutive patients presenting with ACS during 2 years period at a tertiary care hospital were studied. ST segment elevation myocardial infarction (STEMI) was noted only in 7 cases, rest had either non-STEMI or unstable angina. Their comorbid risk factors, echocardiographic left ventricular ejection fraction were noted. All of them undergone invasive coronary angiography followed by revascularization as indicated. Results: Fifty percent of cases presented with reappearance of symptoms within 10 years after surgery. Culprit vessel identified was saphenous vein graft (SVG) in 49% followed by native vessel in (22%), both SVG and native vessel in 15%. Only 14% showed left internal mammary artery (LIMA) graft block at distal anastomotic site. Percutaneous coronary intervention was done in 47, redo CABG surgery in 8 cases. Rest were continued on optimal medical treatment. Of the 47 who have undergone PCI, 14 were done for SVGs and in 4 to LIMA graft to the left anterior descending. PCI to native vessel was done in 22 cases and in 7 one SVG and one native vessel. Conclusions: Post-CABG surgery patients are high risk subset with multiple comorbidities including impaired renal functions. Presentation as STEMI was less common. Majority of them can be managed with PCI of grafts or native vessels or both. Optimal medical treatment was advised in whom intervention or redo CABG is not feasible. More studies are needed comparing post-CABG ACS patients with de novo cases in Indian patients.