Document Detail


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.
MedLine Citation:
PMID:  17242013     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 10 469 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% CI, 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.
Authors:
Claes Held; Per Tornvall; Ulf Stenestrand
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2007-01-22
Journal Detail:
Title:  European heart journal     Volume:  28     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-02-06     Completed Date:  2007-12-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  316-25     Citation Subset:  IM    
Affiliation:
Karolinska Institutet, Department of Medicine, Unit of Cardiology, Karolinska University Hospital, 171 76 Stockholm, Sweden. claes.held@karolinska.se
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MeSH Terms
Descriptor/Qualifier:
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

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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