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. Copyright 2010 Mosby, Inc. All rights reserved.
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. Copyright 2010 Mosby, Inc. All rights reserved.
Authors: Muath Alanbaei; Alawi A Alsheikh-Ali; Tareq Aleinati; Mohammad Zubaid; Mustafa Ridha; Fahad Alenezi; Wael Al-Mahmeed; Kadhim Sulaiman; Jawad Al-Lawati; Haitham Amin; Jassim Al Suwaidi; Ahmed Al-Motarreb Journal: Open Cardiovasc Med J Date: 2011-08-30
Authors: Rafid Al-Aqeedi; Nidal Asaad; Awad Al-Qahtani; Rajvir Singh; Hajar A Al Binali; Abdul Wahid Al Mulla; Jassim Al Suwaidi Journal: PLoS One Date: 2012-07-18 Impact factor: 3.240
Authors: Matthew M Y Lee; Mark C Petrie; Paul Rocchiccioli; Joanne Simpson; Colette E Jackson; David S Corcoran; Kenneth Mangion; Ammani Brown; Pio Cialdella; Novalia P Sidik; Margaret B McEntegart; Aadil Shaukat; Alan P Rae; Stuart H M Hood; Eileen E Peat; Iain N Findlay; Clare L Murphy; Alistair J Cormack; Nikolay B Bukov; Kanarath P Balachandran; Keith G Oldroyd; Ian Ford; Olivia Wu; Alex McConnachie; Sarah J E Barry; Colin Berry Journal: Circ Cardiovasc Interv Date: 2019-07-31 Impact factor: 6.546
Authors: Matthew M Y Lee; Mark C Petrie; Paul Rocchiccioli; Joanne Simpson; Colette E Jackson; David S Corcoran; Kenneth Mangion; Ammani Brown; Pio Cialdella; Novalia P Sidik; Margaret B McEntegart; Aadil Shaukat; Alan P Rae; Stuart H M Hood; Eileen E Peat; Iain N Findlay; Clare L Murphy; Alistair J Cormack; Nikolay B Bukov; Kanarath P Balachandran; Ian Ford; Olivia Wu; Alex McConnachie; Sarah J E Barry; Colin Berry Journal: Open Heart Date: 2021-02
Authors: Matthew M Y Lee; Mark C Petrie; Paul Rocchiccioli; Joanne Simpson; Colette Jackson; Ammani Brown; David Corcoran; Kenneth Mangion; Margaret McEntegart; Aadil Shaukat; Alan Rae; Stuart Hood; Eileen Peat; Iain Findlay; Clare Murphy; Alistair Cormack; Nikolay Bukov; Kanarath Balachandran; Richard Papworth; Ian Ford; Andrew Briggs; Colin Berry Journal: Open Heart Date: 2016-04-20