Clinical presentation of patients with prior coronary artery bypass grafting and suspected acute myocardial infarction.

Koechlin, Luca; Boeddinghaus, Jasper; Nestelberger, Thomas; Miró, Òscar; Fuenzalida, Carolina; Martinez-Nadal, Gemma; López, Beatriz; Wussler, Desiree; Walter, Joan; Zimmermann, Tobias; Troester, Valentina; Lopez-Ayala, Pedro; Baumgartner, Benjamin; Ratmann, Paul David; Diebold, Matthias; Prepoudis, Alexandra; Huber, Jeffrey; Christ, Michael; Wildi, Karin; Rubini Giménez, Maria; ... (2021). Clinical presentation of patients with prior coronary artery bypass grafting and suspected acute myocardial infarction. European heart journal. Acute cardiovascular care, 10(7), pp. 746-755. Oxford University Press 10.1093/ehjacc/zuaa020

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AIMS

Diagnosis of acute myocardial infarction (AMI) can be challenging in patients with prior coronary artery bypass grafting (CABG).

METHODS AND RESULTS

Final diagnoses were adjudicated by two independent cardiologists using the universal definition of AMI among patients presenting to the emergency department (ED) with suspected AMI. Diagnostic accuracy of 34 chest pain characteristics (CPCs) and four electrocardiogram (ECG) signatures stratified according to the presence or absence of prior CABG were prospectively quantified. Among 4015 patients (no prior CABG: n = 3686; prior CABG: n = 329), prevalence of AMI and unstable angina were higher in patients with prior CABG (35% vs. 18%; 26% vs. 8%; both P < 0.001). Three CPCs (9%) and two electrocardiographic findings (50%) showed a different diagnostic performance (interaction P < 0.05) with loss of diagnostic value in patients with prior CABG. The diagnostic accuracy as quantified by the area under the curve (AUC) of the integrated clinical judgement was moderate to good in patients with prior CABG, and significantly lower compared to patients without prior CABG [AUC 0.80 (95% confidence interval (CI) 0.75-0.84) vs. AUC 0.87 (95% CI 0.86-0.89); P = 0.004]. Time to discharge from the ED was significantly longer in patients with prior CABG [359 (215-525) min vs. 300 (192-435) min; P < 0.001]. Key findings were confirmed in a large independent external validation cohort (n = 13 653).

CONCLUSIONS

Patients with prior CABG presenting with suspected AMI have a high prevalence of AMI and unstable angina and lower diagnostic accuracy of CPCs and the ECG, possibly justifying liberal use of early coronary angiography in these vulnerable patients.

CLINICALTRIALS.GOV REGISTRY

Number NCT00470587.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
UniBE Contributor:	Reichlin, Tobias Roman
Subjects:	600 Technology > 610 Medicine & health
ISSN:	2048-8734
Publisher:	Oxford University Press
Language:	English
Submitter:	Vjollca Coli
Date Deposited:	29 Dec 2021 11:02
Last Modified:	05 Dec 2022 16:00
Publisher DOI:	10.1093/ehjacc/zuaa020
PubMed ID:	33620434
Uncontrolled Keywords:	Coronary artery bypass grafting Electrocardiogram Myocardial infarction
URI:	https://boris.unibe.ch/id/eprint/163415