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
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
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. Hirsch, F. Windhausen, J. G.P. Tijssen, A. J.M. Oude Ophuis, W. J. van der Giessen, P. M. van der Zee, J. H. Cornel, F. W.A. Verheugt, R. J. de Winter, and for the Invasive versus Conservative Treatment in Diverging associations of an intended early invasive strategy compared with actual revascularization, and outcome in patients with non-ST-segment elevation acute coronary syndrome: the problem of treatment selection bias Eur. Heart J., March 2, 2009; 30(6): 645 - 654. [Abstract] [Full Text] [PDF]
|
|