•STEMI patients with previous CABG have a higher in-hospital mortality.•Primary PCI use is increasing in STEMI patients with or without CABG.•Primary PCI improves in-hospital mortality in STEMI ...patients with CABG.•A trend of increasing adverse outcomes is observed in STEMI patients with CABG.
Association of history of coronary artery bypass graft surgery (CABG) with clinical outcomes in patients presenting with ST-segment elevation myocardial infarction (STEMI) is unclear from current data.
Using Nationwide Inpatient Sample (NIS) data from 2003 to 2014, adult patients hospitalized with principal diagnosis of STEMI were extracted. The cohort was divided into patients with a history of CABG and those without a history of CABG. The primary outcome measure was in-hospital mortality (IHM).
2,710,375 STEMI patients were included in final analysis of which 110,066 had history of CABG. Patients with history of CABG had higher unadjusted (12.2% vs. 8.8%, P < 0.001) and adjusted (odds ratio OR1.16; 95% confidence interval CI 1.14 to1.19, P < 0.001) IHM compared to those without previous CABG. Compared to a trend of decreasing IHM in STEMI patients without previous CABG, a trend of increasing IHM was observed over the study period in those with a history of previous CABG. Although patients with previous CABG when treated with primary PCI (PPCI) had a higher unadjusted IHM compared to those without previous CABG, (4.8% vs 4.3%, P < 0.001), after adjusting for comorbidities and in-hospital complications no significant increase in IHM was observed in patients with previous CABG treated with PPCI.
STEMI patients with previous CABG have a significantly higher IHM compared to those without previous CABG. PPCI improves IHM with no independent mortality disadvantage attributable to previous CABG.
Methods Nationwide Inpatient Sample data files from 2003 to 2014 were used to extract adult patients (age > 18 years) who underwent elective PCI. Patients who developed major complications (acute ...stroke, gastrointestinal bleeding, acute kidney injury, cardiac arrest, cardiogenic shock, vascular complications, and in-hospital mortality) after PCI were excluded to identify those with uncomplicated hospital stay.
Background
Radial artery occlusion (RAO) remains one of the most important complications of transradial access (TRA). Despite the identification of multiple predictors, the interaction between these ...predictors on the occurrence of RAO has not been evaluated.
Methods
Consecutive patients undergoing TRA coronary angiography (CA) or percutaneous coronary intervention (PCI), were retrospectively analyzed to compare the effect of standard patent hemostasis using a one‐bladder band versus two‐bladder band with simultaneous ipsilateral ulnar artery compression and two introducer sizes on the primary endpoint of RAO. Access was obtained using 6‐Fr slender introducer sheath or 7‐Fr slender introducer sheath and hemostasis with either a one‐bladder band or a two‐bladder band. The radial artery was evaluated using ultrasound.
Results
Total of 2019 patients undergoing CA or PCI were included in the analysis. In the one‐bladder band group, the incidence of RAO with a 6‐Fr slender introducer sheath was 4.2%. In those receiving hemostasis with a two‐bladder band, RAO occurred in 1% of patients receiving a 6‐Fr slender introducer sheath versus 0.9% in those receiving a 7‐Fr slender introducer sheath (p = 0.68). Larger radial artery diameter, larger body weight, and a two‐bladder hemostasis band with ipsilateral ulnar compression were independently associated with a lower incidence of RAO.
Conclusion
A two‐bladder band with simultaneous ipsilateral ulnar artery compression when used for radial artery hemostasis, is associated with a lower incidence of RAO, and can mitigate the penalty for a larger catheter with reassuring implications for use of a 7‐Fr capable system for complex transradial PCI.
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