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.
OBJECTIVE
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.


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).


CONCLUSIONS
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.
Held
Claes
C
Karolinska Institutet, Department of Medicine, Unit of Cardiology, Karolinska University Hospital, 171 76 Stockholm, Sweden. claes.held@karolinska.se
Tornvall
Per
P
Stenestrand
Ulf
U
D054058:Acute Coronary Syndrome / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000401:mortality*; D012008:Recurrence; D012044:Regression Analysis; D012086:Reoperation; D016019:Survival Analysis