European Heart Journal Advance Access originally published online on January 22, 2007
European Heart Journal 2007 28(3):316-325; doi:10.1093/eurheartj/ehl471
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Effects of revascularization within 14 days of hospital admission due to acute coronary syndrome on 1-year mortality in patients with previous coronary artery bypass graft surgery
1 Karolinska Institutet, Department of Medicine, Unit of Cardiology, Karolinska University Hospital, 171 76 Stockholm, Sweden
2 Department of Cardiology, University Hospital of Linköping, Sweden
Received 23 May 2006; revised 21 November 2006; accepted 21 December 2006; online publish-ahead-of-print 22 January 2007.
* Corresponding author. Tel: +46 8 5177 9286; fax: +46 8 32 45 97. E-mail address: claes.held{at}karolinska.se
Aims To determine whether revascularization within 14 days reduces 1-year mortality in patients with a previous CABG admitted for non-ST-elevation ACS. Current guidelines for patients with acute coronary syndrome (ACS) include early revascularization. The evidence is derived from studies, in which patients with previous coronary artery by-pass graft (CABG) surgery often were excluded and thus insufficient to support a similar strategy in these high-risk patients in whom coronary interventions are associated with lower success and higher complication rates.
Methods and results A cohort of 10 469 patients < 80 years old from a national registry, admitted to coronary care units in Sweden, was studied. We obtained 1-year mortality data from the Swedish National Cause of Death Registry. Relative risk (RR) in patients undergoing revascularization within 14 days (n = 4269) of admission compared to those who did not (n = 6200) was calculated by using multivariable logistic regression analyses and propensity scores for the likelihood of early revascularization. At 1-year, unadjusted mortality was 5.4% in the revascularized group and 13.1% in the conservatively treated group. In multiple regression analyses, revascularization was associated with a reduction of 1-year mortality (RR 0.67; 95% CI, 0.56–0.81; P < 0.001).
Conclusion In patients with a previous CABG admitted for ACS, revascularization within 14 days of hospital admission was associated with a marked reduction in 1-year mortality, supporting an early invasive approach also in this subset of patients.
Key Words: Acute coronary syndrome • Invasive strategy • Revascularization