BACKGROUND: The American College of Cardiology/American Health Association guidelines recommend both an early invasive strategy and administration of antiplatelet/anticoagulant therapy for high-risk patients in the absence of contraindications. Little is known about adherence to guideline recommendations in patients with prior coronary artery bypass graft (CABG) surgery presenting with non-ST-segment elevation myocardial infarction (NSTEMI). METHODS: We analyzed 47,557 patients with NSTEMI in the 2007-2008 National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines. Treatment patterns were compared between patients with and without prior CABG surgery. Multivariable regression with generalized estimating equations evaluated the association between prior CABG and in-hospital outcomes. RESULTS: In this study, 8,790 NSTEMI patients (18.5%) had a history of CABG surgery. Prior CABG surgery was associated with a significantly lower adjusted likelihood of early cardiac catheterization (adjusted odds ratio [OR] 0.88, 95% CI 0.83-0.92), higher rates of short-term clopidogrel use (adjusted OR 1.08, 95% CI 1.02-1.14), and comparable use of anticoagulant therapy (adjusted OR 0.96, 95% CI 0.88-1.04). Adjusted risks of bleeding and in-hospital mortality did not differ significantly between the 2 groups (adjusted ORs 1.00, 95% CI 0.92-1.11 and 0.99, 95% CI 0.87-1.11, respectively). CONCLUSIONS: Patients with prior CABG surgery presenting with NSTEMI are often felt to be at high risk for adverse outcomes and therefore require aggressive treatment. Our study indicates that they are less likely to undergo guideline-recommended early cardiac catheterization but equally or more likely to receive guideline-recommended antiplatelet and anticoagulant therapy. This risk-treatment paradox, however, does not appear to negatively influence short-term clinical outcomes.
BACKGROUND: The American College of Cardiology/American Health Association guidelines recommend both an early invasive strategy and administration of antiplatelet/anticoagulant therapy for high-risk patients in the absence of contraindications. Little is known about adherence to guideline recommendations in patients with prior coronary artery bypass graft (CABG) surgery presenting with non-ST-segment elevation myocardial infarction (NSTEMI). METHODS: We analyzed 47,557 patients with NSTEMI in the 2007-2008 National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines. Treatment patterns were compared between patients with and without prior CABG surgery. Multivariable regression with generalized estimating equations evaluated the association between prior CABG and in-hospital outcomes. RESULTS: In this study, 8,790 NSTEMI patients (18.5%) had a history of CABG surgery. Prior CABG surgery was associated with a significantly lower adjusted likelihood of early cardiac catheterization (adjusted odds ratio [OR] 0.88, 95% CI 0.83-0.92), higher rates of short-term clopidogrel use (adjusted OR 1.08, 95% CI 1.02-1.14), and comparable use of anticoagulant therapy (adjusted OR 0.96, 95% CI 0.88-1.04). Adjusted risks of bleeding and in-hospital mortality did not differ significantly between the 2 groups (adjusted ORs 1.00, 95% CI 0.92-1.11 and 0.99, 95% CI 0.87-1.11, respectively). CONCLUSIONS:Patients with prior CABG surgery presenting with NSTEMI are often felt to be at high risk for adverse outcomes and therefore require aggressive treatment. Our study indicates that they are less likely to undergo guideline-recommended early cardiac catheterization but equally or more likely to receive guideline-recommended antiplatelet and anticoagulant therapy. This risk-treatment paradox, however, does not appear to negatively influence short-term clinical outcomes.
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: Muhammad Asrar Ul Haq; Nima Rudd; Mueed Mian; Anastasia Castles; Tamara Mogilevski; Vivek Mutha; William J Van Gaal Journal: Open Heart Date: 2014-06-13
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: Ahmad Shoaib; Muhammad Rashid; Colin Berry; Nick Curzen; Evangelos Kontopantelis; Adam Timmis; Ayesha Ahmad; Tim Kinnaird; Mamas A Mamas Journal: J Am Heart Assoc Date: 2021-10-06 Impact factor: 5.501
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