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Invasive vs non-invasive treatment in acute coronary syndromes and prior bypass surgery.
Int J Cardiol. 2007 Jun 25; 119(1):65-72.IJ

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.

Authors+Show Affiliations

ICyCC Fundación Favaloro, Av. Belgrano 1746 (1093) Capital Federal, Buenos Aires, Argentina. epgurfinkel@ffavaloro.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17045681

Citation

Gurfinkel, Enrique P., et al. "Invasive Vs Non-invasive Treatment in Acute Coronary Syndromes and Prior Bypass Surgery." International Journal of Cardiology, vol. 119, no. 1, 2007, pp. 65-72.
Gurfinkel EP, Perez de la Hoz R, Brito VM, et al. Invasive vs non-invasive treatment in acute coronary syndromes and prior bypass surgery. Int J Cardiol. 2007;119(1):65-72.
Gurfinkel, E. P., Perez de la Hoz, R., Brito, V. M., Duronto, E., Dabbous, O. H., Gore, J. M., & Anderson, F. A. (2007). Invasive vs non-invasive treatment in acute coronary syndromes and prior bypass surgery. International Journal of Cardiology, 119(1), 65-72.
Gurfinkel EP, et al. Invasive Vs Non-invasive Treatment in Acute Coronary Syndromes and Prior Bypass Surgery. Int J Cardiol. 2007 Jun 25;119(1):65-72. PubMed PMID: 17045681.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Invasive vs non-invasive treatment in acute coronary syndromes and prior bypass surgery. AU - Gurfinkel,Enrique P, AU - Perez de la Hoz,Ricardo, AU - Brito,Viviana M, AU - Duronto,Ernesto, AU - Dabbous,Omar H, AU - Gore,Joel M, AU - Anderson,Frederick A,Jr AU - ,, Y1 - 2006/10/12/ PY - 2006/03/30/received PY - 2006/06/20/revised PY - 2006/07/15/accepted PY - 2006/10/19/pubmed PY - 2007/7/4/medline PY - 2006/10/19/entrez SP - 65 EP - 72 JF - International journal of cardiology JO - Int J Cardiol VL - 119 IS - 1 N2 - 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. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/17045681/Invasive_vs_non_invasive_treatment_in_acute_coronary_syndromes_and_prior_bypass_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(06)00905-3 DB - PRIME DP - Unbound Medicine ER -