PMID- 25332800
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20141021
LR  - 20211021
IS  - 2053-3624 (Print)
IS  - 2053-3624 (Electronic)
IS  - 2053-3624 (Linking)
VI  - 1
IP  - 1
DP  - 2014
TI  - Predictors and outcomes of early coronary angiography in patients with prior 
      coronary artery bypass surgery presenting with non-ST elevation myocardial 
      infarction.
PG  - e000059
LID - 10.1136/openhrt-2014-000059 [doi]
LID - e000059
AB  - INTRODUCTION: The best strategy in patients with prior coronary artery bypass 
      graft surgery (CABG) who present with non-ST elevation myocardial infarction 
      (NSTEMI) remains less well defined. We compare the characteristics, therapeutic 
      interventions and outcomes of patients with prior CABG presenting with NSTEMI. 
      METHODS: All patients who presented to our hospital during 2007-2012 with 
      available electronic records were analysed retrospectively. Outcomes were 
      compared between patients who underwent coronary angiography or percutaneous 
      coronary intervention (PCI) versus those who were treated medically. RESULTS: A 
      total of 117 patients were analysed. Of that, 79 patients were managed medically 
      while 38 underwent early angiography, of which only 11 (9.5%) received PCI. 
      Patients treated medically (did not undergo angiography) were older (74+/-10 
      vs70+/-8; p=0.05). ECG changes were the only independent predictor for early 
      angiography (OR 0.4, 95% CI 0.15 to 0.99; p=0.05) while recurrent chest pain (OR 
      0.2, 95% CI 0.05 to 0.97; p=0.05) predicted PCI on multivariate analysis. The PCI 
      group had higher Global Registry of Acute Cardiac Events (GRACE) score (176+/-29 vs 
      150+/-31; p=0.01). No significant difference was found in readmission rates, 
      morbidity (unstable angina pectoris, NSTEMI, ST elevation myocardial infarction 
      (STEMI), or combination) or mortality at 12 months between the groups who 
      underwent angiography, PCI, or treated medically on univariate and multivariate 
      analysis. CONCLUSIONS: The opportunity to intervene in prior CABG patients 
      presenting with NSTEMI is often low. Initial medical management may be a 
      reasonable option in carefully selected patients particularly in the absence of 
      ongoing symptoms, ECG changes or very high GRACE scores. Further studies are 
      required to evaluate the safety of non-invasive strategies in managing this 
      population.
FAU - Asrar Ul Haq, Muhammad
AU  - Asrar Ul Haq M
AD  - Department of Cardiology , The Northern Hospital , Melbourne, Victoria , 
      Australia ; Department of Medicine , University of Melbourne , Melbourne, 
      Victoria , Australia.
FAU - Rudd, Nima
AU  - Rudd N
AD  - Department of Cardiology , The Northern Hospital , Melbourne, Victoria , 
      Australia ; Department of Medicine , University of Melbourne , Melbourne, 
      Victoria , Australia.
FAU - Mian, Mueed
AU  - Mian M
AD  - Department of Cardiology , The Northern Hospital , Melbourne, Victoria , 
      Australia.
FAU - Castles, Anastasia
AU  - Castles A
AD  - Department of Cardiology , The Northern Hospital , Melbourne, Victoria , 
      Australia.
FAU - Mogilevski, Tamara
AU  - Mogilevski T
AD  - Department of Cardiology , The Northern Hospital , Melbourne, Victoria , 
      Australia.
FAU - Mutha, Vivek
AU  - Mutha V
AD  - Department of Cardiology , The Northern Hospital , Melbourne, Victoria , 
      Australia ; Department of Medicine , University of Melbourne , Melbourne, 
      Victoria , Australia.
FAU - Van Gaal, William J
AU  - Van Gaal WJ
AD  - Department of Cardiology , The Northern Hospital , Melbourne, Victoria , 
      Australia ; Department of Medicine , University of Melbourne , Melbourne, 
      Victoria , Australia.
LA  - eng
PT  - Journal Article
DEP - 20140613
PL  - England
TA  - Open Heart
JT  - Open heart
JID - 101631219
PMC - PMC4195928
OTO - NOTNLM
OT  - CARDIAC SURGERY
OT  - CORONARY ARTERY DISEASE
EDAT- 2014/10/22 06:00
MHDA- 2014/10/22 06:01
PMCR- 2014/06/13
CRDT- 2014/10/22 06:00
PHST- 2014/02/17 00:00 [received]
PHST- 2014/05/06 00:00 [revised]
PHST- 2014/05/28 00:00 [accepted]
PHST- 2014/10/22 06:00 [entrez]
PHST- 2014/10/22 06:00 [pubmed]
PHST- 2014/10/22 06:01 [medline]
PHST- 2014/06/13 00:00 [pmc-release]
AID - openhrt-2014-000059 [pii]
AID - 10.1136/openhrt-2014-000059 [doi]
PST - epublish
SO  - Open Heart. 2014 Jun 13;1(1):e000059. doi: 10.1136/openhrt-2014-000059. 
      eCollection 2014.