Evaluation of hospitalization period and five-year follow-up of patients admitted with acute coronary syndrome following coronary artery bypass graft surgery

OBJECTIVES
We evaluated patients admitted with the diagnosisof acute coronary syndrome (ACS) after coronary artery bypass graft (CABG) surgery.

STUDY DESIGN
This retrospective study included 72 consecutive CABG patients (10 women, 62 men; mean age 63±9 years; range 45 to 83 years). Acute coronary syndrome was defined as the presence of unstable angina or myocardial infarction (MI) with or without ST elevation. Time from CABG surgery to admission with ACS was defined as bypass age. Following discharge, information was derived by phone calls from the patients or relatives on cardiovascular events within a five-year period.

RESULTS
On admission, 14 patients (19.4%) had non-ST elevation MI, nine patients (12.5%) had ST elevation MI, and 49 patients (68.1%) had unstable angina. The mean bypass age was 5.6±3.5 years. Of the study group, 38.9% were obese, 25% were diabetic, 54.2% were hypertensive, 44.4% were hyperlipidemic, and 26.4% were current smokers. Medications before admission included aspirin (81.9%), statin (25%), beta-blocker (27.8%), ACE inhibitor or angiotensin receptor blocker (27.8%), and calcium channel antagonist (36.1%). Increased LDL cholesterol (≥100 mg/dl) and decreased HDL cholesterol (≤50 mg/dl) levels were present in 55.6% and 80.6%, respectively. Mortality occurred in 15 patients, four during hospitalization, and 11 after discharge. The overall mortality rate was 21.4%. In correlation analysis, mortality was positively correlated with age (r=0.34, p=0.005), bypass age (r=0.37, p=0.001), CRP level (r=0.31, p=0.033) and negatively correlated with beta-blocker use (r=-0.25, p=0.041) and ejection fraction (r=-0.37, p=0.016).

CONCLUSION
Our results show that, following CABG surgery, special consideration should be given to risk factor management and use of agents with proven effects against cardiovascular mortality such as statins, betablockers, and ACE inhibitors.