Literature DB >> 33637568

Invasive versus medically managed acute coronary syndromes with prior bypass (CABG-ACS): insights into the registry versus randomised trial populations.

Matthew M Y Lee1,2,3,4,5, Mark C Petrie1,2,3, Paul Rocchiccioli2,3, Joanne Simpson1,2, Colette E Jackson1,2,4, David S Corcoran1,2, Kenneth Mangion1,2, Ammani Brown4, Pio Cialdella2, Novalia P Sidik1,2, Margaret B McEntegart1,2,4, Aadil Shaukat2,3, Alan P Rae1,3, Stuart H M Hood1,2,5, Eileen E Peat2,5, Iain N Findlay5, Clare L Murphy5, Alistair J Cormack5, Nikolay B Bukov6, Kanarath P Balachandran6, Ian Ford7, Olivia Wu8, Alex McConnachie7, Sarah J E Barry9, Colin Berry10,2,4.   

Abstract

BACKGROUND: Coronary artery bypass graft (CABG) patients are under-represented in acute coronary syndrome (ACS) trials. We compared characteristics and outcomes for patients who did and did not participate in a randomised trial of invasive versus non-invasive management (CABG-ACS).
METHODS: ACS patients with prior CABG in four hospitals were randomised to invasive or non-invasive management. Non-randomised patients entered a registry. Primary efficacy (composite of all-cause mortality, rehospitalisation for refractory ischaemia/angina, myocardial infarction (MI), heart failure) and safety outcomes (composite of bleeding, stroke, procedure-related MI, worsening renal function) were independently adjudicated.
RESULTS: Of 217 patients screened, 84 (39%) screenfailed, of whom 24 (29%) did not consent and 60 (71%) were ineligible. Of 133 (61%) eligible, 60 (mean±SD age, 71±9 years, 72% male) entered the trial and 73 (age, 72±10 years, 73% male) entered a registry (preferences: physician (79%), patient (38%), both (21%)).Compared with trial participants, registry patients had more valve disease, lower haemoglobin, worse New York Heart Association class and higher frailty.At baseline, invasive management was performed in 52% and 49% trial and registry patients, respectively, of whom 32% and 36% had percutaneous coronary intervention at baseline, respectively (p=0.800). After 2 years follow-up (694 (median, IQR 558-841) days), primary efficacy (43% trial vs 49% registry (HR 1.14, 95% CI 0.69 to 1.89)) and safety outcomes (28% trial vs 22% registry (HR 0.74, 95% CI 0.37 to 1.46)) were similar. EuroQol was lower in registry patients at 1 year.
CONCLUSIONS: Compared with trial participants, registry participants had excess morbidity, but longer-term outcomes were similar. TRIAL REGISTRATION NUMBER: NCT01895751. © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

Entities:  

Keywords:  acute coronary syndrome; coronary angiography; coronary artery bypass; health care; myocardial infarction; outcome assessment

Mesh：

Substances：

Year:  2021        PMID： 33637568      PMCID： PMC7919592          DOI： 10.1136/openhrt-2020-001453

Source DB:  PubMed          Journal:  Open Heart        ISSN： 2053-3624


  19 in total

1.  Long-term clinical outcome in the Bypass Angioplasty Revascularization Investigation Registry: comparison with the randomized trial. BARI Investigators.

Authors:  F Feit; M M Brooks; G Sopko; N M Keller; A Rosen; R Krone; P B Berger; R Shemin; M J Attubato; D O Williams; R Frye; K M Detre
Journal:  Circulation       Date:  2000-06-20       Impact factor: 29.690

2.  Outcomes Following Percutaneous Coronary Intervention in Non-ST-Segment-Elevation Myocardial Infarction Patients With Coronary Artery Bypass Grafts.

Authors:  Ahmad Shoaib; Tim Kinnaird; Nick Curzen; Evangelos Kontopantelis; Peter Ludman; Mark de Belder; Muhammad Rashid; Chun Shing Kwok; James Nolan; Azfar Zaman; Mamas A Mamas
Journal:  Circ Cardiovasc Interv       Date:  2018-11       Impact factor: 6.546

3.  2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI).

Authors:  Stephan Windecker; Philippe Kolh; Fernando Alfonso; Jean-Philippe Collet; Jochen Cremer; Volkmar Falk; Gerasimos Filippatos; Christian Hamm; Stuart J Head; Peter Jüni; A Pieter Kappetein; Adnan Kastrati; Juhani Knuuti; Ulf Landmesser; Günther Laufer; Franz-Josef Neumann; Dimitrios J Richter; Patrick Schauerte; Miguel Sousa Uva; Giulio G Stefanini; David Paul Taggart; Lucia Torracca; Marco Valgimigli; William Wijns; Adam Witkowski
Journal:  Eur Heart J       Date:  2014-08-29       Impact factor: 29.983

4.  Outcomes of patients with prior coronary artery bypass grafting and acute coronary syndromes: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial.

Authors:  Eugenia Nikolsky; Brent T McLaurin; David A Cox; Steven V Manoukian; Ke Xu; Roxana Mehran; Gregg W Stone
Journal:  JACC Cardiovasc Interv       Date:  2012-09       Impact factor: 11.195

5.  Non-invasive assessment of saphenous vein graft patency in asymptomatic patients.

Authors:  P G Campbell; K S L Teo; S G Worthley; M T Kearney; A Tarique; A Natarajan; A G Zaman
Journal:  Br J Radiol       Date:  2009-04       Impact factor: 3.039

6.  Randomized comparison between the invasive and conservative strategies in comorbid elderly patients with non-ST elevation myocardial infarction.

Authors:  Juan Sanchis; Eduardo Núñez; José Antonio Barrabés; Francisco Marín; Luciano Consuegra-Sánchez; Silvia Ventura; Ernesto Valero; Mercè Roqué; Antoni Bayés-Genís; Bruno García Del Blanco; Irene Dégano; Julio Núñez
Journal:  Eur J Intern Med       Date:  2016-08-08       Impact factor: 4.487

Review 7.  Routine invasive strategies versus selective invasive strategies for unstable angina and non-ST elevation myocardial infarction in the stent era.

Authors:  Jonathon P Fanning; Jonathan Nyong; Ian A Scott; Constantine N Aroney; Darren L Walters
Journal:  Cochrane Database Syst Rev       Date:  2016-05-26

8.  A meta-analysis of randomized controlled trials on mid-term angiographic outcomes for radial artery versus saphenous vein in coronary artery bypass graft surgery.

Authors:  Christopher Cao; Su C Ang; Kevin Wolak; Sheen Peeceeyen; Paul Bannon; Tristan D Yan
Journal:  Ann Cardiothorac Surg       Date:  2013-07

Review 9.  The epidemiology of cardiovascular disease in the UK 2014.

Authors:  Prachi Bhatnagar; Kremlin Wickramasinghe; Julianne Williams; Mike Rayner; Nick Townsend
Journal:  Heart       Date:  2015-06-03       Impact factor: 5.994

10.  Predictors and outcomes of early coronary angiography in patients with prior coronary artery bypass surgery presenting with non-ST elevation myocardial infarction.

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
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  1 in total

1.  Intervention and in-hospital pharmacoterapies in octogenarian with acute coronary syndrome: a 10-year retrospective analysis of the Malaysian National Cardiovascular Database (NCVD) registry.

Authors:  Siti Z Suki; Ahmad S M Zuhdi; ' Abqariyah A Yahya; Nur L Zaharan
Journal:  BMC Geriatr       Date:  2022-01-04       Impact factor: 3.921
  1 in total

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