Routine Non-invasive vs Invasive Management in Patients With Prior CABG With a NSTE-ACS: a Randomised Controlled Trial

Lee, M. M.Y. et al. (2018) Routine Non-invasive vs Invasive Management in Patients With Prior CABG With a NSTE-ACS: a Randomised Controlled Trial. British Cardiovascular Intervention Society Young Investigator Award Shortlisted Presentations, London, UK, 30 Nov 2017. A5.2-A6. (doi:10.1136/heartjnl-2018-BCIS.9)

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Abstract

Background: There is an evidence-gap about how to best treat patients with a history of prior CABG presenting with a NSTE-ACS because these patients were excluded from key randomised trials. Methods: The CABG-ACS pilot trial (NCT01895751) randomised patients with a NSTE-ACS and prior CABG to routine invasive or non-invasive management. The primary efficacy outcome was a composite of all-cause death, rehospitalisation for refractory ischaemia/angina, MI and HF hospitalisation. The primary safety outcome was a composite of bleeding, stroke, procedure-related MI and worsening renal function. A CEC assessed events. Results: 60 patients (mean ±SD age 71±9 years, 28% female) were randomised to invasive (n=31) or non-invasive (n=29) management. The invasive group had worse NYHA class (p=0.044) and less valve disease (17% vs 27%; p=0.035). Other comorbidities, age, sex, CCS grade, frailty score and medications were similar. Baseline LIMA grafts were similar (p=0.720). All invasive group patients had invasive management (mean BCIS-1 Jeopardy Score 7±4) and 6 (19%) had PCI. 6 non-invasive group patients ended up having invasive management and 3 (50%) had PCI. No patients had redo CABG. The primary efficacy outcome occurred in 42% invasive vs 45% non-invasive groups (RR (95% CI) 0.94 (0.52, 1.67); p=1.000). The primary safety outcome occurred in 26% invasive vs 31% non-invasive groups (RR 0.83 (0.37, 1.86); p=0.777). EQ-5D was similar at 1 year. Conclusion: Compared with routine non-invasive management, a strategy of routine invasive management was not associated with patient benefits.

Item Type:Conference or Workshop Item
Additional Information:Conference abstract published in Heart 104(Suppl_1): A5-A6.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McConnachie, Professor Alex and Simpson, Dr Joanne and Shaukat, Dr Aadil and Lee, Matthew and McEntegart, Dr Margaret and Petrie, Professor Mark and Brown, Mrs Ammani and Corcoran, Dr David and Mangion, Dr Kenneth and Barry, Dr Sarah and Cormack, Dr Alistair and Jackson, Dr Colette and Ford, Professor Ian and Hood, Dr Stuart and Berry, Professor Colin and Rae, Dr Alan and Findlay, Dr Iain and Balachandran, Dr Kanarath and Wu, Professor Olivia and Sidik, Ms Novalia
Authors: Lee, M. M.Y., Petrie, M. C., Rocchiccioli, P., Simpson, J., Jackson, C., Brown, A., Corcoran, D., Mangion, K., Cialdella, P., Sidik, N., McEntegart, M., Shaukat, A., Rae, A., Hood, S., Peat, E., Findlay, I., Murphy, C., Cormack, A., Bukov, N., Balachandran, K., Ford, I., Wu, O., McConnachie, A., Barry, S., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
ISSN:1355-6037
Published Online:25 January 2018

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