A recent study evaluated the differences between long-term outcomes in patients with acute myocardial infarction (MI) and stable coronary artery disease (CAD) on treatment with coronary artery bypass grafting (CABG). The investigators retrospectively studied patients with MI (n = 1,882) or stable CAD (n = 13,117) treated with isolated CABG for a period of 10 years between 2004 and 2014. Median follow-up was 7.9 years. The results demonstrated that in-hospital mortality (8.6% vs. 1.6%; OR 5.94; p < .0001) and re-sternotomy (5.5% vs. 2.7%; OR 2.07; p < .0001) were more common in MI patients compared to stable CAD patients. At 10-year follow-up, hospital surviving MI patients had higher all-cause mortality (28.2% vs. 22.2%; HR 1.37; p = .002) and rate of major adverse cardiovascular events (34.4% vs. 27.4%; HR 1.22; CI 1.00-1.50; p = .049). Moreover, cardiovascular mortality (15.9% vs. 12.7%; HR 1.36; p = .017) and rate of new MI (12.0% vs. 9.8%; HR 1.40; p = .034) were also greater in patients with MI during follow-up. Follow-up of stabilized first-year survivors showed that the difference in all-cause (26.5% vs. 20.7%; HR 1.40; p = .003) and cardiovascular (14.2% vs. 11.4%; HR 1.37; p = .027) mortality continued to increase between MI and stable CAD patients. The researchers of this study concluded that patients with MI have comparatively poorer short- and long-term outcomes than stable CAD patients after CABG and risk difference continues to rise with time. Higher risk of death also continues in stabilized first-year myocardial infarct survivors. This indicates the importance of efficient secondary prevention and follow-up in post-myocardial infarct patients after CABG.

Source: Ann Med. 2021 Dec;53(1):70-77.