{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:06:50Z","timestamp":1770163610336,"version":"3.49.0"},"reference-count":34,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Patients with a prior history of coronary artery bypass grafting (CABG) who present with non-ST-segment elevation myocardial infarction (NSTEMI) represent a complex, high-risk subgroup due to advanced comorbidity burden and challenging coronary anatomy. Whether an invasive strategy offers meaningful benefit over conservative management in this population remains unclear. Therefore, this study aimed to compare long-term outcomes of percutaneous coronary intervention (PCI) versus medical therapy in NSTEMI patients with previous CABG and to identify independent predictors of major adverse cardiovascular events (MACE) and all-cause mortality. Materials and Methods: This retrospective cohort study included 286 NSTEMI patients with prior CABG (PCI: 112; medical therapy: 174). Baseline demographic, clinical, laboratory, and angiographic characteristics were assessed. The primary endpoint was MACE, while the secondary endpoint was all-cause mortality. Kaplan\u2013Meier analysis evaluated survival differences, and multivariable Cox regression identified independent predictors. Results: During follow-up, MACE rates were comparable between PCI and medical therapy (14.3% vs. 18.9%; p = 0.305). All-cause mortality was likewise similar (9.8% vs. 10.3%; p = 0.541). Kaplan\u2013Meier analysis showed no survival benefit with PCI (log-rank p = 0.334). Hypoalbuminemia independently predicted both MACE and mortality, while CKD and HF were major determinants of long-term mortality. Conclusions: In NSTEMI patients with prior CABG, no long-term superiority of PCI over medical therapy was observed with respect to MACE or mortality. Prognosis appears more closely linked to hypoalbuminemia, CKD, and HF than to the chosen management strategy. These findings underscore the importance of individualized and risk-adapted clinical decision-making in this complex population.<\/jats:p>","DOI":"10.3390\/medicina62020315","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T10:48:01Z","timestamp":1770115681000},"page":"315","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-Term Clinical Outcomes of PCI Versus Medical Therapy in NSTEMI Patients with Prior CABG"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2178-6140","authenticated-orcid":false,"given":"Onur","family":"Alt\u0131nkaya","sequence":"first","affiliation":[{"name":"Department of Cardiology, University of Health Sciences, Erzurum City Hospital, 25240 Erzurum, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6654-2521","authenticated-orcid":false,"given":"Selim","family":"Aydemir","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Health Sciences, Erzurum City Hospital, 25240 Erzurum, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Murat","family":"\u00d6zmen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Health Sciences, Erzurum City Hospital, 25240 Erzurum, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mustafa","family":"\u00d6zko\u00e7","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Health Sciences, Erzurum City Hospital, 25240 Erzurum, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3750-4478","authenticated-orcid":false,"given":"Rauf","family":"Macit","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ka\u011f\u0131zman State Hospital, 36700 Kars, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abuzer","family":"Ocak","sequence":"additional","affiliation":[{"name":"Department of Cardiology, D\u00fczi\u00e7i State Hospital, 80600 Osmaniye, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5765-4281","authenticated-orcid":false,"given":"Emrah","family":"Aksakal","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Health Sciences, Erzurum City Hospital, 25240 Erzurum, Turkey"},{"name":"Department of Medical Pharmacology, Ataturk University, 25030 Erzurum, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e024818","DOI":"10.1161\/JAHA.121.024818","article-title":"Mortality and Cardiovascular Outcomes in Patients Presenting with Non-ST Elevation Myocardial Infarction Despite No Standard Modifiable Risk Factors: Results from the SWEDEHEART Registry","volume":"11","author":"Figtree","year":"2022","journal-title":"J. Am. Heart Assoc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1097\/01.hpc.0000236218.07432.a6","article-title":"Early invasive strategy improves outcomes in patients with acute coronary syndrome with previous coronary artery bypass graft surgery: A report from TACTICS-TIMI 18","volume":"5","author":"Kugelmass","year":"2006","journal-title":"Crit. Pathw. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1903","DOI":"10.1016\/S0140-6736(16)31276-4","article-title":"Early invasive versus non-invasive treatment in patients with non-ST-elevation acute coronary syndrome (FRISC-II): 15 year follow-up of a prospective, randomised, multicentre study","volume":"388","author":"Wallentin","year":"2016","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.jacc.2015.05.051","article-title":"10-Year Mortality Outcome of a Routine Invasive Strategy Versus a Selective Invasive Strategy in Non-ST-Segment Elevation Acute Coronary Syndrome: The British Heart Foundation RITA-3 Randomized Trial","volume":"66","author":"Henderson","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1093\/eurheartj\/ehl471","article-title":"Effects of revascularization within 14 days of hospital admission due to acute coronary syndrome on 1-year mortality in patients with previous coronary artery bypass graft surgery","volume":"28","author":"Held","year":"2007","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.mayocp.2020.05.047","article-title":"Clinical Characteristics, Management Strategies and Outcomes of Acute Myocardial Infarction Patients with Prior Coronary Artery Bypass Grafting","volume":"96","author":"Shoaib","year":"2021","journal-title":"Mayo Clin. Proc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1056\/NEJMoa044259","article-title":"Early invasive versus selectively invasive management for acute coronary syndromes","volume":"353","author":"Windhausen","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"67","DOI":"10.4244\/EIJ-D-20-00975","article-title":"Revascularisation or medical therapy in elderly patients with acute anginal syndromes: The RINCAL randomised trial","volume":"17","author":"Myat","year":"2021","journal-title":"EuroIntervention"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1016\/j.jcin.2012.06.008","article-title":"Early aggressive versus initially conservative treatment in elderly patients with non-ST-segment elevation acute coronary syndrome: A randomized controlled trial","volume":"5","author":"Savonitto","year":"2012","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2380","DOI":"10.1093\/eurheartj\/ehae245","article-title":"Non-ST-elevation acute coronary syndromes with previous coronary artery bypass grafting: A meta-analysis of invasive vs. conservative management","volume":"45","author":"Kelham","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3912","DOI":"10.1093\/eurheartj\/ehae178","article-title":"2024 ESC Guidelines for the management of elevated blood pressure and hypertension","volume":"45","author":"McEvoy","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"542","DOI":"10.7326\/M15-3016","article-title":"Diagnosis and Management of Diabetes: Synopsis of the 2016 American Diabetes Association Standards of Medical Care in Diabetes","volume":"164","author":"Chamberlain","year":"2016","journal-title":"Ann. Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1111\/j.1523-1755.2005.00365.x","article-title":"Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO)","volume":"67","author":"Levey","year":"2005","journal-title":"Kidney Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"117477","DOI":"10.1016\/j.atherosclerosis.2024.117477","article-title":"Outcomes of management strategies in patients with prior coronary artery bypass grafting presenting with an acute coronary syndrome","volume":"393","author":"Gouda","year":"2024","journal-title":"Atherosclerosis"},{"key":"ref_17","first-page":"e92383","article-title":"Impact of Previous Coronary Artery Bypass Grafting on Clinical Outcomes in Patients with Acute Myocardial Infarction: A Systematic Review and Meta-Analysis","volume":"17","author":"Lokesh","year":"2025","journal-title":"Cureus"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e007830","DOI":"10.1161\/CIRCINTERVENTIONS.119.007830","article-title":"Invasive Versus Medical Management in Patients with Prior Coronary Artery Bypass Surgery with a Non-ST Segment Elevation Acute Coronary Syndrome","volume":"12","author":"Lee","year":"2019","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e018823","DOI":"10.1161\/JAHA.120.018823","article-title":"Clinical Characteristics, Management Strategies, and Outcomes of Non-ST-Segment-Elevation Myocardial Infarction Patients with and Without Prior Coronary Artery Bypass Grafting","volume":"10","author":"Shoaib","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.ijcard.2006.07.058","article-title":"Invasive vs non-invasive treatment in acute coronary syndromes and prior bypass surgery","volume":"119","author":"Gurfinkel","year":"2007","journal-title":"Int. J. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e000059","DOI":"10.1136\/openhrt-2014-000059","article-title":"Predictors and outcomes of early coronary angiography in patients with prior coronary artery bypass surgery presenting with non-ST elevation myocardial infarction","volume":"1","author":"Rudd","year":"2014","journal-title":"Open Heart"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1016\/j.jcin.2012.06.009","article-title":"Outcomes of patients with prior coronary artery bypass grafting and acute coronary syndromes: Analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial","volume":"5","author":"Nikolsky","year":"2012","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.ejim.2022.05.004","article-title":"Low serum albumin: A neglected predictor in patients with cardiovascular disease","volume":"102","author":"Manolis","year":"2022","journal-title":"Eur. J. Intern. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"23337214241249914","DOI":"10.1177\/23337214241249914","article-title":"Serum Albumin as Prognostic Marker for Older Adults in Hospital and Community Settings","volume":"10","author":"Riviati","year":"2024","journal-title":"Gerontol. Geriatr. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"9589","DOI":"10.1038\/s41598-025-94061-7","article-title":"The association of nutritional and inflammatory status with cardiovascular and all-cause mortality risk among US patients with metabolic syndrome","volume":"15","author":"Huang","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.jjcc.2014.12.001","article-title":"Impact of hypoalbuminemia, frailty, and body mass index on early prognosis in older patients (\u226585 years) with ST-elevation myocardial infarction","volume":"66","author":"Sujino","year":"2015","journal-title":"J. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"sfae339","DOI":"10.1093\/ckj\/sfae339","article-title":"Differences in association between hypoalbuminaemia and mortality among younger versus older patients on haemodialysis","volume":"18","author":"Floege","year":"2025","journal-title":"Clin. Kidney J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1007\/s11739-025-03882-x","article-title":"Lower albumin levels are associated with 1-year mortality in older patients hospitalized for acute heart failure: THE ALBIMED-HF study","volume":"20","author":"Barbiero","year":"2025","journal-title":"Intern. Emerg. Med."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Nzobokela, J., Muchaili, L., Mwambungu, A., Masenga, S.K., and Kirabo, A. (2025). Pathophysiology and emerging biomarkers of cardiovascular-renal-hepato-metabolic syndrome. Front. Cardiovasc. Med., 12.","DOI":"10.3389\/fcvm.2025.1661563"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"38389","DOI":"10.31083\/RCM38389","article-title":"Renal Dysfunction, Coronary Artery Lesion Complexity, and Adverse Cardiovascular Outcomes in Patients with Acute Coronary Syndrome","volume":"26","author":"Chen","year":"2025","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1016\/j.jacc.2017.04.025","article-title":"2017 ACC\/AHA\/HFSA Focused Update of the 2013 ACCF\/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America","volume":"70","author":"Yancy","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/S0300-8932(10)70089-0","article-title":"Mortality and cause of death in patients with heart failure: Findings at a specialist multidisciplinary heart failure unit","volume":"63","author":"Pons","year":"2010","journal-title":"Rev. Esp. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"263","DOI":"10.21037\/cdt-20-302","article-title":"Pathophysiology of heart failure","volume":"11","author":"Schwinger","year":"2021","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.carrev.2022.06.257","article-title":"Cardiac Catheterizations in Patients with Acute Coronary Syndrome and Prior Coronary Bypass Surgery: Impact of Native vs Graft vs Absent Culprit Lesions on Clinical Outcomes and Treatment Strategy","volume":"44","author":"Groenland","year":"2022","journal-title":"Cardiovasc. Revasc. Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/2\/315\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T11:16:49Z","timestamp":1770117409000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/2\/315"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,3]]},"references-count":34,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["medicina62020315"],"URL":"https:\/\/doi.org\/10.3390\/medicina62020315","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,3]]}}}