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 MedicineCenter for Outcomes Research
Document Type
Journal ArticlePublication Date
2007-06-19Keywords
Acute DiseaseAdrenergic 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
Metadata
Show full item recordAbstract
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 siteDOI
10.1016/j.ijcard.2006.07.058Permanent Link to this Item
http://hdl.handle.net/20.500.14038/27226PubMed ID
17045681Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.ijcard.2006.07.058