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Coronary artery bypass surgery in patients with acute coronary syndromes is difficult to predict.
Am Heart J. 2008 May; 155(5):841-7.AH

Abstract

BACKGROUND

Although the use of clopidogrel in patients "unlikely" to require coronary artery bypass grafting (CABG) is recommended in current guidelines of acute coronary syndrome (ACS) management, an important minority of patients require CABG. We assessed the ability to predict need for CABG from demographics known at the time of ACS presentation, using data from SYNERGY.

METHODS

Patients undergoing CABG at any time after the index angiogram were included. Early CABG was defined as surgery <72 hours after angiography. The relationship between cessation of enoxaparin and glycoprotein IIb/IIIa inhibition, CABG timing, and 30-day death or MI and bleeding events was assessed. Demographic and clinical factors and geographic location were assessed as predictors of early CABG or CABG at any time. The discriminatory utility is reported with the c-index.

RESULTS

Of the 9053 patients undergoing angiography, 1793 (18.1%) received CABG. Early CABG (n = 972) was associated with more bleeding events (39.2% vs 29.4%, P < .001) but not death or MI. The risk of bleeding events diminished when surgery was delayed >18 hours after cessation of enoxaparin and glycoprotein IIb/IIIa inhibition. Clinical factors associated with early CABG included diabetes and lack of prior CABG or clopidogrel. However, overall the logistic regression model had poor discriminatory ability to predict patients likely to require CABG in the setting of an ACS presentation (c-index 0.671).

CONCLUSIONS

It is difficult to predict those high-risk patients with ACS who will undergo surgical revascularization based on baseline clinical characteristics.

Authors+Show Affiliations

Flinders Medical Centre, 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)

Comparative Study
Journal Article

Language

eng

PubMed ID

18440330

Citation

Chew, Derek P., et al. "Coronary Artery Bypass Surgery in Patients With Acute Coronary Syndromes Is Difficult to Predict." American Heart Journal, vol. 155, no. 5, 2008, pp. 841-7.
Chew DP, Mahaffey KW, White HD, et al. Coronary artery bypass surgery in patients with acute coronary syndromes is difficult to predict. Am Heart J. 2008;155(5):841-7.
Chew, D. P., Mahaffey, K. W., White, H. D., Huang, Z., Hoekstra, J. W., Ferguson, J. J., Califf, R. M., & Aylward, P. E. (2008). Coronary artery bypass surgery in patients with acute coronary syndromes is difficult to predict. American Heart Journal, 155(5), 841-7. https://doi.org/10.1016/j.ahj.2007.12.002
Chew DP, et al. Coronary Artery Bypass Surgery in Patients With Acute Coronary Syndromes Is Difficult to Predict. Am Heart J. 2008;155(5):841-7. PubMed PMID: 18440330.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coronary artery bypass surgery in patients with acute coronary syndromes is difficult to predict. AU - Chew,Derek P, AU - Mahaffey,Kenneth W, AU - White,Harvey D, AU - Huang,Zhen, AU - Hoekstra,James W, AU - Ferguson,James J, AU - Califf,Robert M, AU - Aylward,Philip E, Y1 - 2008/02/21/ PY - 2007/08/30/received PY - 2007/12/04/accepted PY - 2008/4/29/pubmed PY - 2008/5/28/medline PY - 2008/4/29/entrez SP - 841 EP - 7 JF - American heart journal JO - Am Heart J VL - 155 IS - 5 N2 - BACKGROUND: Although the use of clopidogrel in patients "unlikely" to require coronary artery bypass grafting (CABG) is recommended in current guidelines of acute coronary syndrome (ACS) management, an important minority of patients require CABG. We assessed the ability to predict need for CABG from demographics known at the time of ACS presentation, using data from SYNERGY. METHODS: Patients undergoing CABG at any time after the index angiogram were included. Early CABG was defined as surgery <72 hours after angiography. The relationship between cessation of enoxaparin and glycoprotein IIb/IIIa inhibition, CABG timing, and 30-day death or MI and bleeding events was assessed. Demographic and clinical factors and geographic location were assessed as predictors of early CABG or CABG at any time. The discriminatory utility is reported with the c-index. RESULTS: Of the 9053 patients undergoing angiography, 1793 (18.1%) received CABG. Early CABG (n = 972) was associated with more bleeding events (39.2% vs 29.4%, P < .001) but not death or MI. The risk of bleeding events diminished when surgery was delayed >18 hours after cessation of enoxaparin and glycoprotein IIb/IIIa inhibition. Clinical factors associated with early CABG included diabetes and lack of prior CABG or clopidogrel. However, overall the logistic regression model had poor discriminatory ability to predict patients likely to require CABG in the setting of an ACS presentation (c-index 0.671). CONCLUSIONS: It is difficult to predict those high-risk patients with ACS who will undergo surgical revascularization based on baseline clinical characteristics. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/18440330/Coronary_artery_bypass_surgery_in_patients_with_acute_coronary_syndromes_is_difficult_to_predict_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(07)01000-9 DB - PRIME DP - Unbound Medicine ER -