Cardiology Department, Rabin Medical Center, Petah Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Heart. 2021 Nov;107(22):1820-1825. doi: 10.1136/heartjnl-2020-318047. Epub 2021 Jan 18.
Patients with prior coronary artery bypass graft surgery (CABG) are at increased risk for recurrent cardiovascular ischaemic events. Advances in management have improved prognosis of patients with acute coronary syndrome (ACS), yet it is not known whether similar trends exist in patients with prior CABG.
Examine temporal trends in the prevalence, treatment and clinical outcomes of patients with prior CABG admitted with ACS.
Time-dependent analysis of patients with or without prior CABG admitted with an ACS who enrolled in the ACS Israeli Surveys between 2000 and 2016. Surveys were divided into early (2000-2008) and late (2010-2016) time periods. Outcomes included 30 days major adverse cardiac events (30d MACE) (death, myocardial infarction, stroke, unstable angina, stent thrombosis, urgent revascularisation) and 1-year mortality.
Among 15 152 patients with ACS, 1506 (9.9%) had a prior CABG. Patients with prior CABG were older (69 vs 63 years), had more comorbidities and presented more with non-ST elevation-ACS (82% vs 51%). Between time periods, utilisation of antiplatelets, statins and percutaneous interventions significantly increased in both groups (p<0.001 for each). The rate of 30d MACE decreased in patients with (19.1%-12.4%, p=0.001) and without (17.4%-9.5%, p<0.001) prior CABG. However, 1-year mortality decreased only in patients without prior CABG (10.5% vs 7.4%, p<0.001) and remained unchanged in patients with prior CABG. Results were consistent after propensity matching.
Despite an improvement in the management and prognosis of patients with ACS in the last decade, the rate of 1-year mortality of patients with prior CABG admitted with an ACS remained unchanged.
接受过冠状动脉旁路移植术（CABG）的患者再次发生心血管缺血性事件的风险增加。急性冠状动脉综合征（ACS）患者管理水平的提高改善了患者的预后，但先前接受过 CABG 的患者是否存在类似趋势尚不清楚。
检查先前接受过 CABG 并因 ACS 住院的患者的患病率、治疗和临床结局的时间趋势。
对 2000 年至 2016 年期间参加 ACS 以色列调查的接受 ACS 治疗的患者进行了有无先前 CABG 的时间依赖性分析。调查分为早期（2000-2008 年）和晚期（2010-2016 年）。结果包括 30 天主要不良心脏事件（30d MACE）（死亡、心肌梗死、中风、不稳定型心绞痛、支架血栓形成、紧急血运重建）和 1 年死亡率。
在 15152 例 ACS 患者中，1506 例（9.9%）有先前的 CABG。先前接受过 CABG 的患者年龄较大（69 岁比 63 岁），合并症较多，表现为非 ST 段抬高型 ACS 的比例较高（82%比 51%）。在两个时间段内，两组患者抗血小板、他汀类药物和经皮介入治疗的使用率均显著增加（每种药物的 p 值均<0.001）。先前接受过 CABG 的患者（19.1%-12.4%，p=0.001）和未接受过 CABG 的患者（17.4%-9.5%，p<0.001）的 30d MACE 发生率均有所下降。然而，只有未接受过 CABG 的患者的 1 年死亡率降低（10.5%比 7.4%，p<0.001），而先前接受过 CABG 的患者的死亡率则保持不变。在倾向评分匹配后，结果仍然一致。
尽管过去十年中 ACS 患者的管理和预后得到了改善，但先前接受过 CABG 并因 ACS 住院的患者的 1 年死亡率仍保持不变。
