Non-ST-elevation acute coronary syndromes with previous coronary artery bypass grafting: a meta-analysis of invasive vs. conservative management.

Autor:	Kelham M; Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK.; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK., Vyas R; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK., Ramaseshan R; Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK.; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK., Rathod K; Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK.; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK., de Winter RJ; Department of Cardiology Heart Center, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands., de Winter RW; Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Bendz B; Department of Cardiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Thiele H; Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany., Hirlekar G; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden., Morici N; IRCCS S. Maria Nascente-Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy., Myat A; Medical Director (Cardiology), Medpace UK, London, UK., Michalis LK; 2nd Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, University Campus, Ioannina 45110, Greece., Sanchis J; Cardiology Department, University Clinic Hospital of València, INCLIVA University of València, CIBER CV, València, Spain., Kunadian V; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust and Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK., Berry C; British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK., Mathur A; Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK.; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK.; NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, UK., Jones DA; Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK.; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK.; NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, UK.
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2024 Jul 12; Vol. 45 (27), pp. 2380-2391.
DOI:	10.1093/eurheartj/ehae245
Abstrakt:	Background and Aims: A routine invasive strategy is recommended in the management of higher risk patients with non-ST-elevation acute coronary syndromes (NSTE-ACSs). However, patients with previous coronary artery bypass graft (CABG) surgery were excluded from key trials that informed these guidelines. Thus, the benefit of a routine invasive strategy is less certain in this specific subgroup. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. A comprehensive search was performed of PubMed, EMBASE, Cochrane, and ClinicalTrials.gov. Eligible studies were RCTs of routine invasive vs. a conservative or selective invasive strategy in patients presenting with NSTE-ACS that included patients with previous CABG. Summary data were collected from the authors of each trial if not previously published. Outcomes assessed were all-cause mortality, cardiac mortality, myocardial infarction, and cardiac-related hospitalization. Using a random-effects model, risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Results: Summary data were obtained from 11 RCTs, including previously unpublished subgroup outcomes of nine trials, comprising 897 patients with previous CABG (477 routine invasive, 420 conservative/selective invasive) followed up for a weighted mean of 2.0 (range 0.5-10) years. A routine invasive strategy did not reduce all-cause mortality (RR 1.12, 95% CI 0.97-1.29), cardiac mortality (RR 1.05, 95% CI 0.70-1.58), myocardial infarction (RR 0.90, 95% CI 0.65-1.23), or cardiac-related hospitalization (RR 1.05, 95% CI 0.78-1.40). Conclusions: This is the first meta-analysis assessing the effect of a routine invasive strategy in patients with prior CABG who present with NSTE-ACS. The results confirm the under-representation of this patient group in RCTs of invasive management in NSTE-ACS and suggest that there is no benefit to a routine invasive strategy compared to a conservative approach with regard to major adverse cardiac events. These findings should be validated in an adequately powered RCT. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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