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Patients with prior coronary artery bypass grafting have a poor outcome after myocardial infarction: an analysis of the VALsartan in acute myocardial iNfarcTion trial (VALIANT).
- Source :
-
European heart journal [Eur Heart J] 2009 Jun; Vol. 30 (12), pp. 1450-6. Date of Electronic Publication: 2009 Apr 03. - Publication Year :
- 2009
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Abstract
- Aims: The number of patients presenting with an acute myocardial infarction (MI) and prior coronary artery bypass grafting (CABG) is increasing. We compared the baseline characteristics, treatment, and clinical outcomes of patients with and without prior CABG in the VALIANT trial.<br />Methods and Results: Of the 14 703 patients with heart failure (HF), left ventricular systolic dysfunction, or both enrolled in VALIANT, 1026 (7%) had prior CABG. Prior CABG patients were older [mean age (SD): 67 (10) vs. 65 (12) years; P < 0.0001], had more comorbidity, and more frequent non-Q wave MI (66 vs. 30%; P < 0.0001). At hospital presentation, prior CABG patients received less aspirin (82 vs. 90%; P < 0.0001) and thrombolysis (21 vs. 36%; P < 0.0001), but had a similar rate of primary percutaneous coronary intervention (14 vs. 15%; P = 0.2). Prior CABG patients were more likely to experience the composite outcome of cardiovascular death, MI, HF, resuscitated cardiac arrest, or stroke; 3 year Kaplan-Meier rate, 64 vs. 39% (adjusted hazard ratio 1.29, 95% confidence interval 1.17-1.43; P < 0.0001).<br />Conclusion: Patients with prior CABG had a worse clinical profile and experienced more fatal and non-fatal outcomes. Greater recognition is necessary for these high-risk patients including optimization of evidence-based secondary preventive therapy.
- Subjects :
- Aged
Coronary Artery Bypass mortality
Coronary Artery Bypass statistics & numerical data
Coronary Artery Disease complications
Female
Heart Failure etiology
Humans
Male
Myocardial Infarction complications
Prognosis
Proportional Hazards Models
Risk Factors
Stroke etiology
Survival Analysis
Thrombolytic Therapy statistics & numerical data
Treatment Outcome
Coronary Artery Bypass adverse effects
Coronary Artery Disease mortality
Myocardial Infarction mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1522-9645
- Volume :
- 30
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- European heart journal
- Publication Type :
- Academic Journal
- Accession number :
- 19346225
- Full Text :
- https://doi.org/10.1093/eurheartj/ehp102