Management patterns of non-ST segment elevation acute coronary syndromes in relation to prior coronary revascularization

Elbarasi, Esam; Goodman, Shaun G.; Yan, Raymond T.; Welsh, Robert C.; Kornder, Jan M.; Wong, Graham C.; Déry, Jean‐Pierre; Anderson, Fred; Gore, Joel M.; Fox, Keith A.A.; Yan, Andrew T.

doi:10.1016/j.ahj.2009.09.019

Cited by 22 publications

(19 citation statements)

References 39 publications

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“…Previous studies from the 1990s 13 and the 2000s 6,9 have suggested that patients with prior bypass surgery have an increased in-hospital mortality, which was likely because of more adverse baseline characteristics in the post-CABG cohort. Our data seem to be in agreement.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Therefore it has been hypothesized that a prior CABG could exert a protective effect, as a result of the double coronary circulation and ischemic preconditioning. 6,9,10 The purpose of this meta-analysis was to systematically review and synthesize existing data on prognosis of patients with ACS and a history of a previous CABG, with respect to in-hospital, short-term and long-term outcomes.…”

mentioning

confidence: 99%

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Prognosis following acute coronary syndromes according to prior coronary artery bypass grafting: Meta-analysis

Teixeira

Vieira

Ribeiro

et al. 2014

European Heart Journal: Acute Cardiovascular Care

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Purpose: Conduct a meta-analysis to study the prognostic influence of a previous coronary artery bypass grafting (CABG) in patients admitted for an acute coronary syndrome (ACS). Methods: A systematic review of the literature was performed using electronic reference databases through January 2013 (MEDLINE, Cochrane Library, Web of Knowledge, Google Scholar and references cited in other studies). Studies in which ACS outcomes with a previous history of CABG were compared with ACS outcomes with no history of previous CABG were considered for inclusion. The main endpoints of interest were mortality and non-fatal acute myocardial infarction. Data was aggregated at three follow-up times using random-effects meta-analysis models. Results: Twenty-four studies were included which provided 387,181 patients for analysis. Previous CABG ACS patients were older, more diabetic and had a more frequent history of a previous myocardial infarction. Pooled in-hospital mortality was higher for the previous CABG ACS patients (OR 1.22 [1.04–1.44], p<0.01, I2 88%). The pooled adjusted OR showed no significant differences for the two groups (adjusted OR 1.13 [0.93–1.37], p=0.22, I2 92%). Previous CABG ACS patient had a higher pooled 30-day mortality (OR 1.28 [1.05–1.55], p=0.02, I2 74%); a higher non-adjusted (OR 1.61 [1.38–1.88], p<0.01, I2 70%) and adjusted (adjusted OR 1.37 [1.15–1.65], p<0.01, I2 0%) long-term mortality. Both the in-hospital and the long-term re-infarction rates were higher for the previous CABG ACS patients. Conclusions: According to our data, ACS patients with previous CABG history had a higher risk for short- and long-term adverse events.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Prognosis following acute coronary syndromes according to prior coronary artery bypass grafting: Meta-analysis

Teixeira

Vieira

Ribeiro

et al. 2014

European Heart Journal: Acute Cardiovascular Care

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“…15 Patients with recurrent angina after CABG are usually elderly and co-morbid health problems are very common. [16][17][18] Redo CABG is uncommon and only performed in o2% of invasively managed acute coronary syndrome patients. 17 In the United Kingdom, of 161 patients who had PCI 126±65 months after CABG, cardiac death, myocardial infarction or repeat PCI occurred in 14% of them by 13 months (mainly related to repeat PCI (12%)).…”

Section: Clinical Use Of Autologous Saphenous Veinmentioning

confidence: 99%

“…[16][17][18] Redo CABG is uncommon and only performed in o2% of invasively managed acute coronary syndrome patients. 17 In the United Kingdom, of 161 patients who had PCI 126±65 months after CABG, cardiac death, myocardial infarction or repeat PCI occurred in 14% of them by 13 months (mainly related to repeat PCI (12%)). In the United Kingdom overall, of the 33 652 PCIs performed in 1999/2000, 907 (2.7%) occurred in patients with prior CABG.…”

Section: Clinical Use Of Autologous Saphenous Veinmentioning

confidence: 99%

Vein graft failure: current clinical practice and potential for gene therapeutics

et al. 2012

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Autologous saphenous vein is commonly used as a conduit to bypass atherosclerotic lesions in coronary and femoral arteries. Despite the wide use of arterial conduits, which are less susceptible to complications and failure, as alternative conduits, the saphenous vein will continue to be used in coronary artery bypass grafting until acceptable alternative approaches are evaluated. Hence, preservation of vein graft patency is essential for the long-term success. Gene therapy is attractive in this setting as an ex-vivo technology to genetically manipulate the conduit before grafting. The use of safe and efficient vectors for delivery is a necessity as well as a strategy to improve patency in the long term. Here, we review the current clinical practice, the pathogenesis of bypass graft failure and adenovirus-mediated gene therapy strategies designed to improve late vein graft failure by modulation of smooth muscle cells in the vein wall.

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“…[205] Compared to patient without prior CABG, patients with prior CABG presenting with ACS are older, have more cardiovascular risk factors, more frequent comorbidities, higher TIMI risk score, lower left ventricular ejection fraction, had higher prevalence of previous treatment with evidence-based medications, were less likely to have ST-segment deviation or positive cardiac biomarker on presentation. [206][207][208][209] During hospitalization prior CABG patients experienced larger infarct size, were less likely to receive reperfusion therapy, early invasive therapy and were more likely to be managed medically when compared to non-CABG patients. [207,209] However, the efficacy of reperfusion therapy in patients with previous CABG is less well characterized.…”

Section: Antithrombotic Therapy During Graft Intervention -mentioning

confidence: 99%

Treatment of Coronary Artery Bypass Graft Failure

Beijk¹,

Harskamp²

2013

Artery Bypass

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Management patterns of non-ST segment elevation acute coronary syndromes in relation to prior coronary revascularization

Abstract: The NSTE-ACS patients with previous PCI were more likely to be treated invasively. Conversely, patients with prior CABG less frequently received invasive therapy. Future studies should determine the appropriateness of this treatment discrepancy.

Cited by 22 publications

References 39 publications

Prognosis following acute coronary syndromes according to prior coronary artery bypass grafting: Meta-analysis

Prognosis following acute coronary syndromes according to prior coronary artery bypass grafting: Meta-analysis

Vein graft failure: current clinical practice and potential for gene therapeutics

Treatment of Coronary Artery Bypass Graft Failure

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