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European Heart Journal Advance Access published online on April 3, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp102
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

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)

Colin Berry1, Karen S. Pieper2, Harvey D. White3, Scott D. Solomon4, Frans Van de Werf5, Eric J. Velazquez2, Aldo P. Maggioni6, Robert M. Califf2, Marc A. Pfeffer4 and John J.V. McMurray1,*

1 Faculty of Medicine, BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA Scotland, UK
2 Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
3 Green Lane Cardiovascular Service, Auckland, New Zealand
4 Brigham and Women's Hospital, Boston, MA, USA
5 University Hospital Gasthuisberg, Leuven, Belgium
6 ANMCO Research Center, Florence, Italy

Received 18 November 2008; revised 29 January 2009; accepted 25 February 2009 * Corresponding author. Tel: +44 141 330 3479, Fax: +44 141 330 6955, Email: j.mcmurray{at}bio.gla.ac.uk

Aims: 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.

Methods and results: 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 < 0.0001], had more comorbidity, and more frequent non-Q wave MI (66 vs. 30%; P < 0.0001). At hospital presentation, prior CABG patients received less aspirin (82 vs. 90%; P < 0.0001) and thrombolysis (21 vs. 36%; P < 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 < 0.0001).

Conclusion: 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.

Key Words: Coronary artery disease • Myocardial infarction • Coronary artery bypass graft • Prognosis


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