الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Our study included 510 patients with acute coronary syndrome and prior CABG. Most patients were elderly at time of presentation. Male gender, DM, BMI ≥30 kg/m2, positive family history of IHD, smoking, hypertension and hyperlipidemia represented the most frequent cardiovascular risk factors. Patients tend to present mainly with NSTEMI-ACS (95.5%) and after the first year from CABG (91.2%). Most of the patients(470 patients) found to have significantly stenosed or occluded bypass venous grafts at presentation and minority of the patients(40 patients) found to have significantly stenosed or occluded arterial grafts with similar cardiovascular risk profile in both groups while differently presenting more early and more with NSTEMI rather than UA in comparison with SVG group.
Female patients tend to present early post CABG(before discharge and during first year of follow up), Hypertensive patients and patients with BMI ≥30 kg/m2, patients presented with myocardial infarction and patients presenting before discharge and during first year after CABG had higher MACCE at 1 year follow up. Regarding treatment plan, 279 patients (54.7%) underwent saphenous graft PCI, 69 patients (13.5%) underwent native coronary arteries PCI, redo CABG done in 33 patients (6.5%) and 129 patient’s (25.3%) referred for medical treatment. MACCE at 1 year occurred in 62 patients(12.2%) with repeated revascularization as the most common event occurred in 37 patients (7.2%) followed by cardiac death in 12 patients(2.4%), MI in 6 patients(1.2%), cerebrovascular infarction in 6 patient(1.2%) and major bleeding in 1 patient(0.2%). Higher rate of cardiac death and MI at 1 year follow up found in native coronary arteries PCI group and redo CABG while survival analysis using Kaplan Maier curve showed better outcome of the medical treatment and venous graft PCI groups in comparison with redo surgery and native artery PCI in short term and better outcome for redo surgery and native artery PCI in long term follow up.
Conclusion and recommendations
Our study included 510 patients with acute coronary syndrome and prior CABG. Most patients were males, elderly at time of presentation and with many cardiovascular risk factors and comorbidities. Most of the patients tend to present with NSTEMI-ACS after the first year from CABG and found to have significantly stenosed or occluded bypass venous grafts at presentation.
Hypertensive and obese patients, patients presented with myocardial infarction and patients presenting before discharge and during first year after CABG had higher MACCE at 1 year follow up. Higher rate of cardiac death and MI at 1 year follow up found in native coronary arteries PCI group and redo CABG while survival analysis using Kaplan Maier curve showed better outcome of the medical treatment and venous graft PCI groups in comparison with redo surgery and native artery PCI in short term and better outcome for redo surgery and native artery PCI in long term follow up.
In patients with ACS after CABG there is no ideal management strategy and management of each case should be individualized and discussed within heart-team based on patients time and mode of presentation, other comorbidities, native coronary anatomy, collateral circulation and type and number of occluded bypass grafts taking in consideration safety and feasibility of the planned procedure in addition to short and long term outcomes.
Based on these data we recommend conduction of a similar study on the Egyptian population to assess the differences in presentation and outcome of management, also the conduction of a large randomized controlled trial comparing treatment strategies in patients with ACS and prior CABG.