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)

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: Simpson, Dr Joanne and McEntegart, Dr Margaret and Corcoran, Dr David and Mangion, Dr Kenneth and Cormack, Dr Alistair and Jackson, Dr Colette and Hood, Dr Stuart and Rae, Dr Alan and Findlay, Dr Iain and Balachandran, Dr Bala and Wu, Professor Olivia and McConnachie, Professor Alex and Shaukat, Dr Aadil and Lee, Matthew and Petrie, Professor Mark and Brown, Mrs Ammani and Barry, Dr Sarah and Ford, Professor Ian and Berry, Professor Colin 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 > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• ISSN: 1355-6037
• Published Online: 25 January 2018