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Management patterns of non-ST segment elevation acute coronary syndromes in relation to prior coronary revascularization.
Am Heart J 2010; 159(1):40-6AH

Abstract

BACKGROUND

Contemporary guidelines support an early invasive strategy for non-ST elevation acute coronary syndrome (NSTE-ACS) patients who had prior coronary revascularization. However, little is known about the management pattern of these patients in "real world."

METHODS

We analyzed 3 consecutive Canadian registries (ACS I, ACS II, and Global Registry of Acute Coronary Events [GRACE]/expanded-GRACE) that recruited 12,483 NSTE-ACS patients from June 1999 to December 2007. We stratified the study population according to prior coronary revascularization status into 4 groups and compared their clinical characteristics, in-hospital use of medications, and cardiac procedures.

RESULTS

Of the 12,483 NSTE-ACS patients, 71.2% had no prior revascularization, 14.2% had percutaneous coronary intervention (PCI) only, 9.5% had coronary artery bypass graft surgery (CABG) only, and 5% had both PCI and CABG. Compared to their counterparts without prior revascularization, patients with previous PCI and/or CABG were more likely to be male, to have diabetes, myocardial infarction, and heart failure but less likely to have ST-segment deviation or positive cardiac biomarker on presentation. Early use of evidence-based medications was higher among patients with previous PCI only and lower among patients with previous CABG only. After adjusting for possible confounders including GRACE risk score, prior PCI was independently associated with in-hospital use of cardiac catheterization (adjusted odds ratio [OR] 1.18, 95% CI 1.04-1.34, P = .008). In contrast, previous CABG was an independent negative predictor (adjusted OR .77, 95% CI 0.68-0.87, P < .001). There was no significant interaction (P = .93) between previous PCI and CABG.

CONCLUSIONS

The NSTE-ACS patients with previous PCI were more likely to be treated invasively. Conversely, patients with prior CABG less frequently received invasive therapy. Future studies should determine the appropriateness of this treatment discrepancy.

Authors+Show Affiliations

Terrence Donnelly Heart Center, Division of Cardiology, St Michael's Hospital, University of Toronto, and Canadian Heart Research Centre, Toronto, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20102865

Citation

Elbarasi, Esam, et al. "Management Patterns of non-ST Segment Elevation Acute Coronary Syndromes in Relation to Prior Coronary Revascularization." American Heart Journal, vol. 159, no. 1, 2010, pp. 40-6.
Elbarasi E, Goodman SG, Yan RT, et al. Management patterns of non-ST segment elevation acute coronary syndromes in relation to prior coronary revascularization. Am Heart J. 2010;159(1):40-6.
Elbarasi, E., Goodman, S. G., Yan, R. T., Welsh, R. C., Kornder, J., Wong, G. C., ... Yan, A. T. (2010). Management patterns of non-ST segment elevation acute coronary syndromes in relation to prior coronary revascularization. American Heart Journal, 159(1), pp. 40-6. doi:10.1016/j.ahj.2009.09.019.
Elbarasi E, et al. Management Patterns of non-ST Segment Elevation Acute Coronary Syndromes in Relation to Prior Coronary Revascularization. Am Heart J. 2010;159(1):40-6. PubMed PMID: 20102865.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management patterns of non-ST segment elevation acute coronary syndromes in relation to prior coronary revascularization. AU - Elbarasi,Esam, AU - Goodman,Shaun G, AU - Yan,Raymond T, AU - Welsh,Robert C, AU - Kornder,Jan, AU - Wong,Graham C, AU - Déry,Jean-Pierre, AU - Anderson,Fred, AU - Gore,Joel M, AU - Fox,Keith A A, AU - Yan,Andrew T, AU - ,, AU - ,, PY - 2009/05/04/received PY - 2009/09/18/accepted PY - 2010/1/28/entrez PY - 2010/1/28/pubmed PY - 2010/3/3/medline SP - 40 EP - 6 JF - American heart journal JO - Am. Heart J. VL - 159 IS - 1 N2 - BACKGROUND: Contemporary guidelines support an early invasive strategy for non-ST elevation acute coronary syndrome (NSTE-ACS) patients who had prior coronary revascularization. However, little is known about the management pattern of these patients in "real world." METHODS: We analyzed 3 consecutive Canadian registries (ACS I, ACS II, and Global Registry of Acute Coronary Events [GRACE]/expanded-GRACE) that recruited 12,483 NSTE-ACS patients from June 1999 to December 2007. We stratified the study population according to prior coronary revascularization status into 4 groups and compared their clinical characteristics, in-hospital use of medications, and cardiac procedures. RESULTS: Of the 12,483 NSTE-ACS patients, 71.2% had no prior revascularization, 14.2% had percutaneous coronary intervention (PCI) only, 9.5% had coronary artery bypass graft surgery (CABG) only, and 5% had both PCI and CABG. Compared to their counterparts without prior revascularization, patients with previous PCI and/or CABG were more likely to be male, to have diabetes, myocardial infarction, and heart failure but less likely to have ST-segment deviation or positive cardiac biomarker on presentation. Early use of evidence-based medications was higher among patients with previous PCI only and lower among patients with previous CABG only. After adjusting for possible confounders including GRACE risk score, prior PCI was independently associated with in-hospital use of cardiac catheterization (adjusted odds ratio [OR] 1.18, 95% CI 1.04-1.34, P = .008). In contrast, previous CABG was an independent negative predictor (adjusted OR .77, 95% CI 0.68-0.87, P < .001). There was no significant interaction (P = .93) between previous PCI and CABG. CONCLUSIONS: The NSTE-ACS patients with previous PCI were more likely to be treated invasively. Conversely, patients with prior CABG less frequently received invasive therapy. Future studies should determine the appropriateness of this treatment discrepancy. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/20102865/Management_patterns_of_non_ST_segment_elevation_acute_coronary_syndromes_in_relation_to_prior_coronary_revascularization_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(09)00817-5 DB - PRIME DP - Unbound Medicine ER -