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Surgical versus percutaneous revascularization for multivessel disease in patients with acute coronary syndromes: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial.
JACC Cardiovasc Interv 2010; 3(10):1059-67JC

Abstract

OBJECTIVES

The aim of this study was to evaluate outcomes of patients with moderate- and high-risk acute coronary syndromes (ACS) and multivessel coronary artery disease managed with percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG).

BACKGROUND

There is uncertainty about the preferred revascularization strategy for high-risk patients with multivessel disease.

METHODS

Among 13,819 moderate- and high-risk ACS patients enrolled in the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial, 5,627 had multivessel disease (including left anterior descending artery involvement) and were managed by PCI (n = 4,412) or CABG (n = 1,215). Propensity score matching was applied to adjust for differences in baseline clinical and angiographic characteristics, yielding a total of 1,056 patients (528 managed by PCI, and 528 managed by CABG).

RESULTS

Propensity-matched patients undergoing CABG had higher 1-month rates of stroke (1.1% vs. 0.0%, p = 0.03) and myocardial infarction (13.3% vs. 8.8%, p = 0.03), received more blood transfusions (40.3% vs. 6.3%, p < 0.0001) and more frequently developed acute renal injury (31.7% vs. 14.2%, p < 0.0001), whereas PCI was associated with higher rates of unplanned revascularization at both 1 month and at 1 year (0.8% vs. 5.2%, p < 0.0001; and 3.8% vs. 16.5%, p < 0.0001, respectively). There were no significant differences between the CABG and PCI groups in 1-month or 1-year mortality (2.5% vs. 2.1%, p = 0.69; and 4.4% vs. 5.7%, p = 0.58, respectively).

CONCLUSIONS

In this propensity-matched comparison from the ACUITY trial, moderate- and high-risk patients with ACS and multivessel disease treated with PCI rather than CABG had lower rates of peri-procedural stroke, myocardial infarction, major bleeding, and renal injury, with comparable 1-month and 1-year rates of mortality, but more frequently developed recurrent ischemia requiring repeat revascularization procedures during follow-up. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ACS]; NCT00093158).

Authors+Show Affiliations

Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York 10022, USA.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 available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

20965465

Citation

Ben-Gal, Yanai, et al. "Surgical Versus Percutaneous Revascularization for Multivessel Disease in Patients With Acute Coronary Syndromes: Analysis From the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) Trial." JACC. Cardiovascular Interventions, vol. 3, no. 10, 2010, pp. 1059-67.
Ben-Gal Y, Moses JW, Mehran R, et al. Surgical versus percutaneous revascularization for multivessel disease in patients with acute coronary syndromes: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. JACC Cardiovasc Interv. 2010;3(10):1059-67.
Ben-Gal, Y., Moses, J. W., Mehran, R., Lansky, A. J., Weisz, G., Nikolsky, E., ... Stone, G. W. (2010). Surgical versus percutaneous revascularization for multivessel disease in patients with acute coronary syndromes: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. JACC. Cardiovascular Interventions, 3(10), pp. 1059-67. doi:10.1016/j.jcin.2010.06.017.
Ben-Gal Y, et al. Surgical Versus Percutaneous Revascularization for Multivessel Disease in Patients With Acute Coronary Syndromes: Analysis From the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) Trial. JACC Cardiovasc Interv. 2010;3(10):1059-67. PubMed PMID: 20965465.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical versus percutaneous revascularization for multivessel disease in patients with acute coronary syndromes: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. AU - Ben-Gal,Yanai, AU - Moses,Jeffrey W, AU - Mehran,Roxana, AU - Lansky,Alexandra J, AU - Weisz,Giora, AU - Nikolsky,Eugenia, AU - Argenziano,Michael, AU - Williams,Matthew R, AU - Colombo,Antonio, AU - Aylward,Philip E, AU - Stone,Gregg W, PY - 2010/06/14/received PY - 2010/06/27/accepted PY - 2010/10/23/entrez PY - 2010/10/23/pubmed PY - 2011/2/10/medline SP - 1059 EP - 67 JF - JACC. Cardiovascular interventions JO - JACC Cardiovasc Interv VL - 3 IS - 10 N2 - OBJECTIVES: The aim of this study was to evaluate outcomes of patients with moderate- and high-risk acute coronary syndromes (ACS) and multivessel coronary artery disease managed with percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG). BACKGROUND: There is uncertainty about the preferred revascularization strategy for high-risk patients with multivessel disease. METHODS: Among 13,819 moderate- and high-risk ACS patients enrolled in the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial, 5,627 had multivessel disease (including left anterior descending artery involvement) and were managed by PCI (n = 4,412) or CABG (n = 1,215). Propensity score matching was applied to adjust for differences in baseline clinical and angiographic characteristics, yielding a total of 1,056 patients (528 managed by PCI, and 528 managed by CABG). RESULTS: Propensity-matched patients undergoing CABG had higher 1-month rates of stroke (1.1% vs. 0.0%, p = 0.03) and myocardial infarction (13.3% vs. 8.8%, p = 0.03), received more blood transfusions (40.3% vs. 6.3%, p < 0.0001) and more frequently developed acute renal injury (31.7% vs. 14.2%, p < 0.0001), whereas PCI was associated with higher rates of unplanned revascularization at both 1 month and at 1 year (0.8% vs. 5.2%, p < 0.0001; and 3.8% vs. 16.5%, p < 0.0001, respectively). There were no significant differences between the CABG and PCI groups in 1-month or 1-year mortality (2.5% vs. 2.1%, p = 0.69; and 4.4% vs. 5.7%, p = 0.58, respectively). CONCLUSIONS: In this propensity-matched comparison from the ACUITY trial, moderate- and high-risk patients with ACS and multivessel disease treated with PCI rather than CABG had lower rates of peri-procedural stroke, myocardial infarction, major bleeding, and renal injury, with comparable 1-month and 1-year rates of mortality, but more frequently developed recurrent ischemia requiring repeat revascularization procedures during follow-up. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ACS]; NCT00093158). SN - 1876-7605 UR - https://www.unboundmedicine.com/medline/citation/20965465/Surgical_versus_percutaneous_revascularization_for_multivessel_disease_in_patients_with_acute_coronary_syndromes:_analysis_from_the_ACUITY__Acute_Catheterization_and_Urgent_Intervention_Triage_Strategy__trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-8798(10)00548-0 DB - PRIME DP - Unbound Medicine ER -