Invasive versus medically managed acute coronary syndromes with prior bypass (CABG-ACS): insights into the registry versus randomised trial populations. Issue 1 (26th February 2021)

• Record Type: Journal Article
• Authors: Lee, Matthew M Y; Petrie, Mark C; Rocchiccioli, Paul; Simpson, Joanne; Jackson, Colette E; Corcoran, David S; Mangion, Kenneth; Brown, Ammani; Cialdella, Pio; Sidik, Novalia P; McEntegart, Margaret B; Shaukat, Aadil; Rae, Alan P; Hood, Stuart H M; Peat, Eileen E; Findlay, Iain N; Murphy, Clare L; Cormack, Alistair J; Bukov, Nikolay B; Balachandran, Kanarath P; Ford, Ian; Wu, Olivia; McConnachie, Alex; Barry, Sarah J E; Berry, Colin
• Is Part Of: Open heart. Volume 8:Issue 1(2021)
• Publication Date: 2021-02-26
• Subjects: coronary angiography -- coronary artery bypass -- acute coronary syndrome -- myocardial infarction -- outcome assessment -- health care; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Patients -- Periodicals; 616.12005
• DOI: 10.1136/openhrt-2020-001453
• Languages: English
• ISSNs: 2398-595X

Abstract

Abstract : Background: Coronary artery bypass graft (CABG) patients are under-represented in acute coronary syndrome (ACS) trials. We compared characteristics and outcomes for patients who did and did not participate in a randomised trial of invasive versus non-invasive management (CABG-ACS). Methods: ACS patients with prior CABG in four hospitals were randomised to invasive or non-invasive management. Non-randomised patients entered a registry. Primary efficacy (composite of all-cause mortality, rehospitalisation for refractory ischaemia/angina, myocardial infarction (MI), heart failure) and safety outcomes (composite of bleeding, stroke, procedure-related MI, worsening renal function) were independently adjudicated. Results: Of 217 patients screened, 84 (39%) screenfailed, of whom 24 (29%) did not consent and 60 (71%) were ineligible. Of 133 (61%) eligible, 60 (mean±SD age, 71±9 years, 72% male) entered the trial and 73 (age, 72±10 years, 73% male) entered a registry (preferences: physician (79%), patient (38%), both (21%)). Compared with trial participants, registry patients had more valve disease, lower haemoglobin, worse New York Heart Association class and higher frailty. At baseline, invasive management was performed in 52% and 49% trial and registry patients, respectively, of whom 32% and 36% had percutaneous coronary intervention at baseline, respectively (p=0.800). After 2 years follow-up (694 (median, IQR 558–841) days), primary efficacy (43% trial vs 49% registry (HR 1.14, 95% CI 0.69 to 1.89)) and safety outcomes (28% trial vs 22% registry (HR 0.74, 95% CI 0.37 to 1.46)) were similar. EuroQol was lower in registry patients at 1 year. Conclusions: Compared with trial participants, registry participants had excess morbidity, but longer-term outcomes were similar. Trial registration number: NCT01895751 .