{
  "abstract": "Introduction Patients with a history of coronary artery bypass grafting (CABG) who subsequently present with acute coronary syndrome (ACS) represent a high-risk and underrepresented subgroup. Their complex coronary anatomy and comorbidity burden introduce uncertainty around optimal management. This study aimed to evaluate 12-month clinical outcomes in patients managed with percutaneous coronary intervention (PCI) and optimal medical therapy versus those managed with medical therapy alone.Methods This retrospective cohort study was conducted across two tertiary centres in Manchester, United Kingdom, including patients presenting between January 2022 and January 2023. Eligible patients had a history of CABG and fulfilled the diagnostic criteria, as per the 4th Universal definition for myocardial infarction (MI). Patients were stratified into PCI and non-PCI groups. The primary outcome was all-cause mortality at 12 months. Secondary outcomes included recurrent chest pain, non-fatal MI, repeat angiography, and further PCI. Group comparisons were made using p-values to access statistical significance.Results 124 patients were included (PCI: n=65; medical therapy only: n=59). Baseline demographics, GRACE scores, and ECG findings were comparable ( table 1). Chronic kidney disease (CKD) was more prevalent in the non-PCI group (40.7% vs 7.7%), likely influencing management decisions. At 12 months, mortality was numerically lower in the PCI group (12.3% vs 23.3%, p=0.096), though not statistically significant (table 2). However, PCI patients had higher rates of recurrent chest pain (23.1% vs 11.9%), non-fatal MI (18.5% vs 6.8%), repeat angiography (21.5% vs 8.5%, p=0.044), and further PCI (18.5% vs 5.1%, p=0.023).Conclusion While PCI may offer a trend toward reduced mortality, it was associated with increased symptom burden and re-intervention. Standard risk tools such as GRACE may not fully account for graft complexity or comorbidity profiles. These findings highlight the need for CABG-specific risk models and underscore the importance of nuanced, patient-tailored decision-making.Abstract 51 Table 1Baseline characteristics Characteristics Medical therapy only (n=59) PCI & Medical therapy (n=65) Baseline Demographics Age (mean ± SD) 71.3 ± 11.7 70.5 ± 8.2 Male 50 (84.7%) 57 (87.7%) Ethnicity White 45 (76.3%) 40 (61.5%) Black 1 (1.7%) 0 (0%) Asian 10 (16.9%) 15 (23.1%) Mixed 2 (3.4%) 0 (0%) Other/Unknown 1 (1.7%) 10 (15.4%) Clinical Presentation Grace score (mean ± SD) 121.4 ± 26.8 121.6 ± 25.7 Raised Troponin 54 (91.5%) 60 (92.3%) ECG Changes ST elevation 4 (6.8%) 8 (12.3%) ST depression 13 (22%) 22 (33.8%) T wave changes 20 (33.9%) 12 (18.5%) Other acute changes 7 (11.9%) 4 (6.2%) LBBB 3 (5.1%) 2 (3.1%) Past Medical History Previous MI 55 (93.2%) 46 (70.8%) Previous Angina 29 (49.2%) 22 (33.8%) Hypertension 49 (83.1%) 53 (81.5%) Diabetes 32 (54.2%) 32 (49.2%) Hypercholesterolaemia 43 (72.9%) 47 (72.3%) Peripheral Vascular Disease 6 (10.2%) 6 (9.2%) Cerebrovascular disease 7 (11.9%) 6 (9.2%) Asthma/COPD 7 (11.9%) 7 (10.8%) CKD 24 (40.7%) 5 (7.7%) Heart Failure 21 (35.6%) 15 (23.1%) Atrial Fibrillation 12 (20.3%) 13 (20%) Smoking Status Never smoked 26 (44.1%) 34 (52.3%) Ex-smoker 26 (44.1%) 23 (35.4%) Current smoker 6 (10.2%) 8 (12.3%) Abstract 51 Table 2Clinical outcomes at 12 months by PCI status Outcome Medical therapy only (n = 59) PCI & Medical therapy (n=65) p-value Death 14 (23.3%) 8 (12.3%) 0.096 Non-fatal MI 4 (6.8%) 12 (18.5%) 0.053 Angiogram 5 (8.5%) 14 (21.5%) 0.044 PCI 3 (5.1%) 12 (18.5%) 0.023 Chest pain recurrence 7 (11.9%) 15 (23.1%) 0.103 Repeat CABG 0 (0%) 0 (0%) /",
  "authors": [
    {
      "affiliations": [
        "Manchester Foundation Trust, Manchester, UK"
      ],
      "name": "FA Manan"
    },
    {
      "affiliations": [
        "Manchester Foundation Trust, Manchester, UK"
      ],
      "name": "J Morris"
    },
    {
      "affiliations": [
        "Manchester Foundation Trust, Manchester, UK"
      ],
      "name": "G Horsfall"
    },
    {
      "affiliations": [
        "Manchester Foundation Trust, Manchester, UK"
      ],
      "name": "S Sastry"
    },
    {
      "affiliations": [
        "Manchester Foundation Trust, Manchester, UK"
      ],
      "name": "B Liu"
    }
  ],
  "title": "51 Retrospective analysis of clinical outcomes for patients with previous coronary artery bypass presenting with acute coronary syndrome",
  "uid": "7555f0fa-8555-5041-9c34-90baf4bfd550"
}