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    Invasive vs non-invasive treatment in acute coronary syndromes and prior bypass surgery

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    Authors
    Gurfinkel, Enrique P.
    Perez de la Hoz, Ricardo
    Brito, Viviana M.
    Duronto, Ernesto
    Dabbous, Omar H.
    Gore, Joel M.
    Anderson, Frederick A. Jr.
    UMass Chan Affiliations
    Department of Medicine, Division of Cardiolovascular Medicine
    Center for Outcomes Research
    Document Type
    Journal Article
    Publication Date
    2007-06-19
    Keywords
    Acute Disease
    Adrenergic beta-Antagonists
    Aged
    Angina Pectoris
    Angioplasty, Balloon, Coronary
    Angiotensin-Converting Enzyme Inhibitors
    Anticoagulants
    Calcium Channel Blockers
    Coronary Artery Bypass
    Female
    Follow-Up Studies
    Humans
    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Male
    Middle Aged
    Multivariate Analysis
    Myocardial Infarction
    Myocardial Ischemia
    Patient Readmission
    Platelet Aggregation Inhibitors
    Predictive Value of Tests
    Recurrence
    Registries
    Risk Factors
    Treatment Outcome
    Health Services Research
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    http://dx.doi.org/10.1016/j.ijcard.2006.07.058
    Abstract
    BACKGROUND: We evaluated the association between invasive and non-invasive management and hospital and 6-month outcomes in patients with a prior coronary artery bypass graft (CABG) who experienced an acute coronary syndrome. METHODS: Data were analysed from patients with a prior CABG who developed an acute coronary syndrome and were enrolled in the Global Registry of Acute Coronary Events. From 44,991 patients included in the study, 3853 fulfilled the inclusion criteria. Of these, 3356 received non-invasive treatment approaches while 497 underwent invasive treatment (percutaneous coronary intervention [PCI] within 48 h of admission). RESULTS: The primary composite endpoint of death, non-fatal myocardial infarction, and recurrent ischaemia during hospitalization was similar in patients in the non-invasive and invasive groups (31% vs 30%, respectively; P=0.53). The rates of hospital mortality (non-invasive 3.4% vs invasive 3.2%) and non-fatal myocardial infarction (3.4% vs 5.1%, respectively) were similar. At 6-month follow-up, the mortality rate was 6.5% in the non-invasive group vs 3.4% in the invasive group (P<0.02); the combined endpoint of death or myocardial infarction was lower in the invasive group (P<0.01). Multivariable analysis showed that, at 6-month follow-up, the combined endpoint of death, non-fatal myocardial infarction, and rehospitalization for heart disease was similar (P=0.10). A greater proportion of patients in the invasive group required unscheduled diagnostic and therapeutic invasive procedures compared with those in the non-invasive group (angiography 15.4% vs 8.1%; PCI 10% vs 5.0%; both P<0.001). CONCLUSIONS: The results from this observational study show no statistically significant differences in hospital outcomes between acute coronary syndrome patients with a prior CABG who undergo invasive or non-invasive treatment. Invasively treated patients experienced higher rates of readmission and additional cardiac procedures than non-invasively treated patients but a lower incidence of cardiovascular complications at 6 months.
    Source
    Int J Cardiol. 2007 Jun 25;119(1):65-72. Epub 2006 Oct 12. Link to article on publisher's site
    DOI
    10.1016/j.ijcard.2006.07.058
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/27226
    PubMed ID
    17045681
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ijcard.2006.07.058
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