Gurfinkel Enrique P, Perez de la Hoz Ricardo, Brito Viviana M, Duronto Ernesto, Dabbous Omar H, Gore Joel M, Anderson Frederick A
ICyCC Fundación Favaloro, Av. Belgrano 1746 (1093) Capital Federal, Buenos Aires, Argentina.
Int J Cardiol. 2007 Jun 25;119(1):65-72. doi: 10.1016/j.ijcard.2006.07.058. Epub 2006 Oct 12.
We evaluated the association between invasive and non-invasive management and hospital and 6-month outcomes in patients with a prior coronary artery bypass graft (CABG) who experienced an acute coronary syndrome.
Data were analysed from patients with a prior CABG who developed an acute coronary syndrome and were enrolled in the Global Registry of Acute Coronary Events. From 44,991 patients included in the study, 3853 fulfilled the inclusion criteria. Of these, 3356 received non-invasive treatment approaches while 497 underwent invasive treatment (percutaneous coronary intervention [PCI] within 48 h of admission).
The primary composite endpoint of death, non-fatal myocardial infarction, and recurrent ischaemia during hospitalization was similar in patients in the non-invasive and invasive groups (31% vs 30%, respectively; P=0.53). The rates of hospital mortality (non-invasive 3.4% vs invasive 3.2%) and non-fatal myocardial infarction (3.4% vs 5.1%, respectively) were similar. At 6-month follow-up, the mortality rate was 6.5% in the non-invasive group vs 3.4% in the invasive group (P<0.02); the combined endpoint of death or myocardial infarction was lower in the invasive group (P<0.01). Multivariable analysis showed that, at 6-month follow-up, the combined endpoint of death, non-fatal myocardial infarction, and rehospitalization for heart disease was similar (P=0.10). A greater proportion of patients in the invasive group required unscheduled diagnostic and therapeutic invasive procedures compared with those in the non-invasive group (angiography 15.4% vs 8.1%; PCI 10% vs 5.0%; both P<0.001).
The results from this observational study show no statistically significant differences in hospital outcomes between acute coronary syndrome patients with a prior CABG who undergo invasive or non-invasive treatment. Invasively treated patients experienced higher rates of readmission and additional cardiac procedures than non-invasively treated patients but a lower incidence of cardiovascular complications at 6 months.
我们评估了既往有冠状动脉旁路移植术（CABG）且发生急性冠状动脉综合征的患者，其侵入性和非侵入性治疗与住院及6个月预后之间的关联。
对既往有CABG且发生急性冠状动脉综合征并纳入全球急性冠状动脉事件注册研究的患者数据进行分析。在纳入研究的44991例患者中，3853例符合纳入标准。其中，3356例接受非侵入性治疗方法，497例接受侵入性治疗（入院后48小时内行经皮冠状动脉介入治疗[PCI]）。
非侵入性组和侵入性组患者住院期间死亡、非致命性心肌梗死和复发性缺血的主要复合终点相似（分别为31%和30%；P=0.53）。住院死亡率（非侵入性组为3.4%，侵入性组为3.2%）和非致命性心肌梗死发生率（分别为3.4%和5.1%）相似。在6个月随访时，非侵入性组死亡率为6.5%，侵入性组为3.4%（P<0.02）；侵入性组死亡或心肌梗死的复合终点较低（P<0.01）。多变量分析显示，在6个月随访时，死亡、非致命性心肌梗死和因心脏病再次住院的复合终点相似（P=0.10）。与非侵入性组相比，侵入性组中需要进行非计划诊断和治疗性侵入性操作的患者比例更高（血管造影分别为15.4%和8.1%；PCI分别为10%和5.0%；均P<0.001）。
这项观察性研究的结果表明，既往有CABG的急性冠状动脉综合征患者接受侵入性或非侵入性治疗，住院结局在统计学上无显著差异。侵入性治疗的患者比非侵入性治疗的患者再入院率和额外心脏操作率更高，但6个月时心血管并发症发生率更低。
