Back to Search
Start Over
Invasive Versus Medical Management in Patients With Prior Coronary Artery Bypass Surgery With a Non-ST Segment Elevation Acute Coronary Syndrome
- Source :
- Circulation. Cardiovascular Interventions
- Publication Year :
- 2019
-
Abstract
- Supplemental Digital Content is available in the text.<br />Background: The benefits of routine invasive management in patients with prior coronary artery bypass grafts presenting with non-ST elevation acute coronary syndromes are uncertain because these patients were excluded from pivotal trials. Methods: In a multicenter trial, non-ST elevation acute coronary syndromes patients with prior coronary artery bypass graft were prospectively screened in 4 acute hospitals. Medically stabilized patients were randomized to invasive management (invasive group) or noninvasive management (medical group). The primary outcome was adherence with the randomized strategy by 30 days. A blinded, independent Clinical Event Committee adjudicated predefined composite outcomes for efficacy (all-cause mortality, rehospitalization for refractory ischemia/angina, myocardial infarction, hospitalization because of heart failure) and safety (major bleeding, stroke, procedure-related myocardial infarction, and worsening renal function). Results: Two hundred seventeen patients were screened and 60 (mean±SD age, 71±9 years, 72% male) were randomized (invasive group, n=31; medical group, n=29). One-third (n=10) of the participants in the invasive group initially received percutaneous coronary intervention. In the medical group, 1 participant crossed over to invasive management on day 30 but percutaneous coronary intervention was not performed. During 2-years’ follow-up (median [interquartile range], 744 [570–853] days), the composite outcome for efficacy occurred in 13 (42%) subjects in the invasive group and 13 (45%) subjects in the medical group. The composite safety outcome occurred in 8 (26%) subjects in the invasive group and 9 (31%) subjects in the medical group. An efficacy or safety outcome occurred in 17 (55%) subjects in the invasive group and 16 (55%) subjects in the medical group. Health status (EuroQol 5 Dimensions) and angina class in each group were similar at 12 months. Conclusions: More than half of the population experienced a serious adverse event. An initial noninvasive management strategy is feasible. A substantive health outcomes trial of invasive versus noninvasive management in non-ST elevation acute coronary syndromes patients with prior coronary artery bypass grafts appears warranted. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01895751.
- Subjects :
- Male
Time Factors
Health Status
Pilot Projects
Coronary Artery Disease
Patient Readmission
acute coronary syndrome
Percutaneous Coronary Intervention
Risk Factors
Cause of Death
Humans
Prospective Studies
Coronary Artery Bypass
Non-ST Elevated Myocardial Infarction
Aged
coronary artery bypass surgery
Aged, 80 and over
Cardiovascular Agents
clinical trial
Original Articles
Middle Aged
United Kingdom
Treatment Outcome
myocardial infarction
ComputingMethodologies_DOCUMENTANDTEXTPROCESSING
Female
coronary angiography
Subjects
Details
- ISSN :
- 19417632
- Volume :
- 12
- Issue :
- 8
- Database :
- OpenAIRE
- Journal :
- Circulation. Cardiovascular interventions
- Accession number :
- edsair.pmid..........61bddba1ee46e1b53cf9bc526a51867f