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

被引:21
作者
Held, Claes [1 ]
Tornvall, Per
Stenestrand, Ulf
机构
[1] Karolinska Univ Hosp, Karolinska Inst, Dept Med, Unit Cardiol, S-17176 Stockholm, Sweden
[2] Linkoping Univ Hosp, Dept Cardiol, S-58185 Linkoping, Sweden
关键词
acute coronary syndrome; invasive strategy; revascularization;
D O I
10.1093/eurheartj/ehl471
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:316 / 325
页数:10
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