Invasive versus medically managed acute coronary syndromes with prior bypass (CABG-ACS): insights into the registry versus randomised trial populations
| Autor: | Mark C. Petrie, Alan P. Rae, Nikolay Bukov, Alistair Cormack, Stuart Hood, Eileen Peat, Ammani Brown, Sarah Barry, Kenneth Mangion, Kanarath Balachandran, Paul Rocchiccioli, David Corcoran, Colette E. Jackson, Clare Murphy, Pio Cialdella, Iain N Findlay, Colin Berry, Novalia Sidik, Joanne Simpson, Margaret McEntegart, Alex McConnachie, Ian Ford, Aadil Shaukat, Olivia Wu, Matthew M.Y. Lee |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Acute coronary syndrome New York Heart Association Class medicine.medical_treatment Renal function Coronary Artery Disease acute coronary syndrome Angina Fibrinolytic Agents QA273 Internal medicine Preoperative Care medicine Humans Diseases of the circulatory (Cardiovascular) system Thrombolytic Therapy Myocardial infarction Registries Stroke outcome assessment Aged business.industry Percutaneous coronary intervention medicine.disease health care coronary artery bypass Treatment Outcome myocardial infarction Heart failure RC666-701 Female coronary angiography Cardiology and Cardiovascular Medicine business |
| Zdroj: | Open Heart, Vol 8, Iss 1 (2021) Open Heart |
| ISSN: | 2053-3624 |
| Popis: | BackgroundCoronary artery bypass graft (CABG) patients are under-represented in acute coronary syndrome (ACS) trials. We compared characteristics and outcomes for patients who did and did not participate in a randomised trial of invasive versus non-invasive management (CABG-ACS).MethodsACS patients with prior CABG in four hospitals were randomised to invasive or non-invasive management. Non-randomised patients entered a registry. Primary efficacy (composite of all-cause mortality, rehospitalisation for refractory ischaemia/angina, myocardial infarction (MI), heart failure) and safety outcomes (composite of bleeding, stroke, procedure-related MI, worsening renal function) were independently adjudicated.ResultsOf 217 patients screened, 84 (39%) screenfailed, of whom 24 (29%) did not consent and 60 (71%) were ineligible. Of 133 (61%) eligible, 60 (mean±SD age, 71±9 years, 72% male) entered the trial and 73 (age, 72±10 years, 73% male) entered a registry (preferences: physician (79%), patient (38%), both (21%)).Compared with trial participants, registry patients had more valve disease, lower haemoglobin, worse New York Heart Association class and higher frailty.At baseline, invasive management was performed in 52% and 49% trial and registry patients, respectively, of whom 32% and 36% had percutaneous coronary intervention at baseline, respectively (p=0.800). After 2 years follow-up (694 (median, IQR 558–841) days), primary efficacy (43% trial vs 49% registry (HR 1.14, 95% CI 0.69 to 1.89)) and safety outcomes (28% trial vs 22% registry (HR 0.74, 95% CI 0.37 to 1.46)) were similar. EuroQol was lower in registry patients at 1 year.ConclusionsCompared with trial participants, registry participants had excess morbidity, but longer-term outcomes were similar.Trial registration numberNCT01895751. |
| Databáze: | OpenAIRE |
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