title: Association of prior coronary artery bypass graft surgery with quality of care of patients with non-ST-segment elevation myocardial infarction: a report from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines.
abstract: BACKGROUND
  The American College of Cardiology/American Health Association guidelines recommend both an early invasive strategy and administration of antiplatelet/anticoagulant therapy for high-risk patients in the absence of contraindications. Little is known about adherence to guideline recommendations in patients with prior coronary artery bypass graft (CABG) surgery presenting with non-ST-segment elevation myocardial infarction (NSTEMI).
  
  
  METHODS
  We analyzed 47,557 patients with NSTEMI in the 2007-2008 National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines. Treatment patterns were compared between patients with and without prior CABG surgery. Multivariable regression with generalized estimating equations evaluated the association between prior CABG and in-hospital outcomes.
  
  
  RESULTS
  In this study, 8,790 NSTEMI patients (18.5%) had a history of CABG surgery. Prior CABG surgery was associated with a significantly lower adjusted likelihood of early cardiac catheterization (adjusted odds ratio [OR] 0.88, 95% CI 0.83-0.92), higher rates of short-term clopidogrel use (adjusted OR 1.08, 95% CI 1.02-1.14), and comparable use of anticoagulant therapy (adjusted OR 0.96, 95% CI 0.88-1.04). Adjusted risks of bleeding and in-hospital mortality did not differ significantly between the 2 groups (adjusted ORs 1.00, 95% CI 0.92-1.11 and 0.99, 95% CI 0.87-1.11, respectively).
  
  
  CONCLUSIONS
  Patients with prior CABG surgery presenting with NSTEMI are often felt to be at high risk for adverse outcomes and therefore require aggressive treatment. Our study indicates that they are less likely to undergo guideline-recommended early cardiac catheterization but equally or more likely to receive guideline-recommended antiplatelet and anticoagulant therapy. This risk-treatment paradox, however, does not appear to negatively influence short-term clinical outcomes.
authors.affiliation: University of Washington School of Medicine, Seattle, WA, USA. mshkim@u.washington.edu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kim
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.forename: Fang-Shu
authors.initials: FS
authors.lastname: Ou
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Klein
authors.forename: Paul A
authors.initials: PA
authors.lastname: Hudson
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001026:Coronary Artery Bypass; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors