PURPOSE:To compare the in-hospital and the medium term outcomes of an invasive strategy versus a conservative one in the subgroup of patients with an acute coronary syndromes (ACS)and previous CABG (coronary artery bypass grafting).
METHODS:Prospective, continuous, observational study of 73 consecutive patients admitted for an ACS with a previous history of CABG. Patients were then divided in two groups: A (n=35 patients) –conservative strategy; B (n=38 patients) –invasive strategy. A one year follow up targeting all cause mortality and major adverse cardiovascular endpoints was performed.
RESULTS:Group A patients were older (71.67+/-8.14 versus 66,56+/-10.30, p=0.006), more diabetic, and more frequently pre medicated with beta blockers, ACE inhibitors and diuretics. Group B patients had more frequent past history of coronary percutaneuos intervention (OR 2.646 p=0.033), received more frequently GP IIb/IIIa inhibitors, and at discharge were more often on double antiplatelet therapy (OR 5.091 p<0.001). Both groups were no different in terms of other risk factors for coronary heart disease, TIMI risk score, rate of STEMI, ejection fraction (44.84%+/-10.88 versus 47.89+/-12.56 p=0.276), cardiac biomarkers, and renal function. The median time after CABG for the present ACS was similar for both patients [9.5 (5.5 –1.3) years vs 9.0 (4.0 –11.25) years p = 0.43)], as well as the coronary anatomy before surgery. Both groups had a similar rate of venous and arterial surgical bypass. The conservative group had a trend for a higher in hospitalar mortality (12.7% versus 6.0%, p=0.325). A similar trend was identified for the one year all cause mortality (11.5% vs 8.6%, log rank p=0.7). The cumulative freedom from MACE at 1 year were 76.9% vs 78.8%, log rank p 0.92, respectivly.
CONCLUSION:The benefits of an invasive strategy for the previous CABG ACS patients were not so significant as would be expected, probably related to our small serie.
CLINICAL IMPLICATIONS:The usefulness of an invasive strategy in the previous CABG ACS patients.
DISCLOSURE:Rogerio Teixeira, None.