| Autor: |
Iain N Findlay, Alan P. Rae, Eileen Peat, Alex McConnachie, Kenneth Mangion, Sarah Barry, Olivia Wu, Nikolay Bukov, Paul Rocchiccioli, Alistair Cormack, Stuart Hood, Pio Cialdella, Ian Ford, Ammani Brown, Joanne Simpson, Matthew M.Y. Lee, Colette E. Jackson, Mark C. Petrie, Colin Berry, Novalia Sidik, Aadil Shaukat, David Corcoran, Kanarath Balachandran, Margaret McEntegart, Clare Murphy |
| Rok vydání: |
2018 |
| Předmět: |
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| Zdroj: |
Abstracts. |
| DOI: |
10.1136/heartjnl-2018-bcis.9 |
| Popis: |
Background There is an evidence-gap about how to best treat patients with a history of prior CABG presenting with a NSTE-ACS because these patients were excluded from key randomised trials. Methods The CABG-ACS pilot trial (NCT01895751) randomised patients with a NSTE-ACS and prior CABG to routine invasive or non-invasive management. The primary efficacy outcome was a composite of all-cause death, rehospitalisation for refractory ischaemia/angina, MI and HF hospitalisation. The primary safety outcome was a composite of bleeding, stroke, procedure-related MI and worsening renal function. A CEC assessed events. Results 60 patients (mean ±SD age 71±9 years, 28% female) were randomised to invasive (n=31) or non-invasive (n=29) management. The invasive group had worse NYHA class (p=0.044) and less valve disease (17% vs 27%; p=0.035). Other comorbidities, age, sex, CCS grade, frailty score and medications were similar. Baseline LIMA grafts were similar (p=0.720). All invasive group patients had invasive management (mean BCIS-1 Jeopardy Score 7±4) and 6 (19%) had PCI. 6 non-invasive group patients ended up having invasive management and 3 (50%) had PCI. No patients had redo CABG. The primary efficacy outcome occurred in 42% invasive vs 45% non-invasive groups (RR (95% CI) 0.94 (0.52, 1.67); p=1.000). The primary safety outcome occurred in 26% invasive vs 31% non-invasive groups (RR 0.83 (0.37, 1.86); p=0.777). EQ-5D was similar at 1 year. Conclusion Compared with routine non-invasive management, a strategy of routine invasive management was not associated with patient benefits. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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