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Patients with non-ST-elevation acute coronary syndromes undergoing coronary artery bypass grafting in the modern era of antithrombotic therapy.
Am Heart J. 2008 Feb; 155(2):239-44.AH

Abstract

BACKGROUND

Many high-risk patients with non-ST-elevation acute coronary syndromes within the SYNERGY trial required coronary artery bypass grafting (CABG) for optimal revascularization. We explored the clinical outcomes among high-risk patients undergoing CABG and the impact of modern pharmacology.

METHODS

We evaluated 180-day rates of death and myocardial infarction (MI) and 30-day GUSTO severe bleeding among patients undergoing CABG, contrasting them with patients undergoing percutaneous coronary intervention (PCI) or medical management. The relationships between perioperative MI, bleeding events, and 6-month mortality were explored. The effect of random assignment to unfractionated heparin or enoxaparin and the relationships between use of clopidogrel and glycoprotein IIb/IIIa inhibitors and clinical outcomes were assessed.

RESULTS

Death or MI at 6 months was more common among patients requiring CABG (CABG 31.2%, PCI 15.9%, medical 9.9%). Thirty-day GUSTO severe bleeding was also higher (CABG 6.4%, PCI 1.1%, medical 0.9%). Perioperative MI and GUSTO severe bleeding were associated with excess 6-month mortality (hazard ratio 2.1, 95% CI 1.27-3.53 and hazard ratio 7.6, CI 4.78-12.09, respectively). Randomization to enoxaparin was not associated with an increase in bleeding or a reduction in death or MI. No differences in ischemic outcomes were observed among patients given glycoprotein IIb/IIIa inhibition or clopidogrel.

CONCLUSIONS

High-risk patients still commonly require CABG with greater bleeding and ischemic event rates observed. Current definitions of perioperative MI and GUSTO severe bleeding portend an increased in 6-month mortality among CABG patients. Modern pharmacotherapies do not appear to impact these higher event rates.

Authors+Show Affiliations

Flinders Medical Centre, South Australia, Adelaide, Australia. derek.chew@flinders.edu.auNo 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
Randomized Controlled Trial

Language

eng

PubMed ID

18215592

Citation

Chew, Derek P., et al. "Patients With non-ST-elevation Acute Coronary Syndromes Undergoing Coronary Artery Bypass Grafting in the Modern Era of Antithrombotic Therapy." American Heart Journal, vol. 155, no. 2, 2008, pp. 239-44.
Chew DP, Huang Z, Pieper KS, et al. Patients with non-ST-elevation acute coronary syndromes undergoing coronary artery bypass grafting in the modern era of antithrombotic therapy. Am Heart J. 2008;155(2):239-44.
Chew, D. P., Huang, Z., Pieper, K. S., White, H., Mahaffey, K. W., Ferguson, J. J., Califf, R. M., & Aylward, P. G. (2008). Patients with non-ST-elevation acute coronary syndromes undergoing coronary artery bypass grafting in the modern era of antithrombotic therapy. American Heart Journal, 155(2), 239-44. https://doi.org/10.1016/j.ahj.2007.10.002
Chew DP, et al. Patients With non-ST-elevation Acute Coronary Syndromes Undergoing Coronary Artery Bypass Grafting in the Modern Era of Antithrombotic Therapy. Am Heart J. 2008;155(2):239-44. PubMed PMID: 18215592.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patients with non-ST-elevation acute coronary syndromes undergoing coronary artery bypass grafting in the modern era of antithrombotic therapy. AU - Chew,Derek P, AU - Huang,Zhen, AU - Pieper,Karen S, AU - White,Harvey, AU - Mahaffey,Kenneth W, AU - Ferguson,James J, AU - Califf,Robert M, AU - Aylward,Philip G, Y1 - 2007/11/26/ PY - 2007/01/19/received PY - 2007/10/01/accepted PY - 2008/1/25/pubmed PY - 2008/2/19/medline PY - 2008/1/25/entrez SP - 239 EP - 44 JF - American heart journal JO - Am Heart J VL - 155 IS - 2 N2 - BACKGROUND: Many high-risk patients with non-ST-elevation acute coronary syndromes within the SYNERGY trial required coronary artery bypass grafting (CABG) for optimal revascularization. We explored the clinical outcomes among high-risk patients undergoing CABG and the impact of modern pharmacology. METHODS: We evaluated 180-day rates of death and myocardial infarction (MI) and 30-day GUSTO severe bleeding among patients undergoing CABG, contrasting them with patients undergoing percutaneous coronary intervention (PCI) or medical management. The relationships between perioperative MI, bleeding events, and 6-month mortality were explored. The effect of random assignment to unfractionated heparin or enoxaparin and the relationships between use of clopidogrel and glycoprotein IIb/IIIa inhibitors and clinical outcomes were assessed. RESULTS: Death or MI at 6 months was more common among patients requiring CABG (CABG 31.2%, PCI 15.9%, medical 9.9%). Thirty-day GUSTO severe bleeding was also higher (CABG 6.4%, PCI 1.1%, medical 0.9%). Perioperative MI and GUSTO severe bleeding were associated with excess 6-month mortality (hazard ratio 2.1, 95% CI 1.27-3.53 and hazard ratio 7.6, CI 4.78-12.09, respectively). Randomization to enoxaparin was not associated with an increase in bleeding or a reduction in death or MI. No differences in ischemic outcomes were observed among patients given glycoprotein IIb/IIIa inhibition or clopidogrel. CONCLUSIONS: High-risk patients still commonly require CABG with greater bleeding and ischemic event rates observed. Current definitions of perioperative MI and GUSTO severe bleeding portend an increased in 6-month mortality among CABG patients. Modern pharmacotherapies do not appear to impact these higher event rates. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/18215592/Patients_with_non_ST_elevation_acute_coronary_syndromes_undergoing_coronary_artery_bypass_grafting_in_the_modern_era_of_antithrombotic_therapy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(07)00781-8 DB - PRIME DP - Unbound Medicine ER -