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Invasive vs non-invasive treatment in acute coronary syndromes and prior bypass surgery
Enrique P Gurfinkel1, Ricardo Perez de la Hoz, Viviana M Brito
1ICyCC Fundación Favaloro, Av. Belgrano 1746 (1093) Capital Federal, Buenos Aires, Argentina. epgurfinkel@ffavaloro.org
Insights
For acute coronary syndrome patients with prior coronary artery bypass graft (CABG), invasive treatment showed similar hospital outcomes but fewer 6-month cardiovascular complications than non-invasive management. Invasive care led to more readmissions and procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Evaluating management strategies for acute coronary syndrome (ACS) in patients with prior coronary artery bypass graft (CABG).
- Assessing the impact of invasive versus non-invasive treatment on hospital and 6-month outcomes.
Purpose of the Study:
- To compare hospital and 6-month outcomes in ACS patients with prior CABG based on invasive vs. non-invasive management.
- To identify differences in mortality, myocardial infarction, and rehospitalization rates between treatment groups.
Main Methods:
- Analysis of data from the Global Registry of Acute Coronary Events.
- Inclusion of 3853 patients with prior CABG and ACS.
- Comparison of outcomes between 3356 patients receiving non-invasive treatment and 497 undergoing invasive treatment (PCI within 48h).
Main Results:
- Similar primary composite endpoints (death, MI, ischemia) during hospitalization (31% vs. 30%, P=0.53).
- Comparable hospital mortality (3.4% vs. 3.2%) and non-fatal MI (3.4% vs. 5.1%).
- Lower 6-month mortality (3.4% vs. 6.5%, P<0.02) and combined death/MI endpoint (P<0.01) in the invasive group; higher rates of unscheduled procedures in the invasive group.
Conclusions:
- No significant difference in hospital outcomes between invasive and non-invasive management for ACS patients with prior CABG.
- Invasive treatment associated with higher readmission rates and additional procedures but lower 6-month cardiovascular complications.
Background:
We evaluated the association between invasive and non-invasive management and hospital and 6-month outcomes in patients with a prior coronary artery bypass graft (CABG) who experienced an acute coronary syndrome.
Methods:
Data were analysed from patients with a prior CABG who developed an acute coronary syndrome and were enrolled in the Global Registry of Acute Coronary Events. From 44,991 patients included in the study, 3853 fulfilled the inclusion criteria. Of these, 3356 received non-invasive treatment approaches while 497 underwent invasive treatment (percutaneous coronary intervention [PCI] within 48 h of admission).
Results:
The primary composite endpoint of death, non-fatal myocardial infarction, and recurrent ischaemia during hospitalization was similar in patients in the non-invasive and invasive groups (31% vs 30%, respectively; P=0.53). The rates of hospital mortality (non-invasive 3.4% vs invasive 3.2%) and non-fatal myocardial infarction (3.4% vs 5.1%, respectively) were similar. At 6-month follow-up, the mortality rate was 6.5% in the non-invasive group vs 3.4% in the invasive group (P<0.02); the combined endpoint of death or myocardial infarction was lower in the invasive group (P<0.01). Multivariable analysis showed that, at 6-month follow-up, the combined endpoint of death, non-fatal myocardial infarction, and rehospitalization for heart disease was similar (P=0.10). A greater proportion of patients in the invasive group required unscheduled diagnostic and therapeutic invasive procedures compared with those in the non-invasive group (angiography 15.4% vs 8.1%; PCI 10% vs 5.0%; both P<0.001).
Conclusions:
The results from this observational study show no statistically significant differences in hospital outcomes between acute coronary syndrome patients with a prior CABG who undergo invasive or non-invasive treatment. Invasively treated patients experienced higher rates of readmission and additional cardiac procedures than non-invasively treated patients but a lower incidence of cardiovascular complications at 6 months.
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