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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
Karolinska Univ Hosp, Dept Cardiol, Stockholm. (UCR)
2007 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 28, no 3, 316-325 p.Article in journal (Refereed) Published
Abstract [en]

Aims 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. Methods and results A cohort of 10469 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% Cl, 0.56-0.81; P< 0.001). Conclusion 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.

Place, publisher, year, edition, pages
2007. Vol. 28, no 3, 316-325 p.
Keyword [en]
Acute Coronary Syndrome/mortality/*surgery, Adult, Aged, Coronary Artery Bypass/*mortality, Death; Sudden; Cardiac/etiology, Female, Humans, Length of Stay, Male, Middle Aged, Myocardial Revascularization/*mortality, Recurrence, Regression Analysis, Reoperation, Survival Analysis
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Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-17362DOI: 10.1093/eurheartj/ehl471ISI: 000244259800011PubMedID: 17242013OAI: oai:DiVA.org:uu-17362DiVA: diva2:45133
Available from: 2008-06-19 Created: 2008-06-19 Last updated: 2017-12-08Bibliographically approved

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Held, Claes

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