Mortality benefit of coronary angioplasty vs. conservative strategy in patients with prior coronary artery bypass surgery presenting with non-ST elevation myocardial infarction
Notice bibliographique
Résumé
Abstract Background Patients with prior coronary artery bypass graft (CABG) surgery have been excluded or under-represented in many of the trials of percutaneous coronary intervention (PCI) vs. conservative strategy in the management of patients presenting with non-ST elevation myocardial infarction (NSTEMI). Therefore, limited data supports the use of PCI in this context. Given the higher risk profile of these patients, clinicians may default to a conservative strategy given the lack of evidence of benefit of PCI. Our institution consists of one PCI and one non-PCI acute site and serves a population of 500 000 including a uniquely high proportion of the elderly with a high follow up rate and an ideal, interesting population to study with many patients offered a conservative strategy. Methodology Patients who presented over a 5 year period from Jan 2012 to Dec 2017 with NSTEMI and prior CABG were identified from Myocardial Ischaemia National Audit Project (MINAP) returns. Hospital records were reviewed to exclude patients with type 2 MI and ST elevation MI. We identified patients who were managed conservatively or with PCI and assessed outcomes at the end pf December 2019, giving a follow up range of 2–7 years. The primary outcome was all cause death or myocardial infarction. Secondary outcome measures included readmission at 30 days and 1 year, angina, need for revascularisation. Results 206 patients were identified (mean age 77.7y, 26% female) of whom 107 were managed medically and 99 underwent angiography. 74 (36%) of patients were admitted to the non-interventional site, of which 27 patients underwent angiography. Overall, 48 (23%) went on to have PCI (only 7% of patients from the non-PCI site). 29 patients had PCI to the native coronaries, 16 to a bypass graft and the remainder to both. Age and clinical frailty score (CFS) was significantly higher in patients managed conservatively. The primary end point occurred in a high proportion of patients (124, 74.6%) consisting of 28 MI and 96 deaths during the follow up period. Age at presentation, clinical frailty score (CFS), presence of heart failure and absence of statin use were were significantly associated with the primary outcome. There was a significant difference in the primary outcome in patients managed conservatively (113/158; 72%) compared to those who had PCI (11/48; 23%), P<0.001. Conclusion PCI in NSTEMI patients with prior CABG is significantly associated with improved survival and less myocardial infarction compared to a conservative strategy in this retrospective audit of our patient population, but PCI patients are younger and less frail, which, in themselves, could suggest treatment bias and might confer a survival benefit. PCI rates varied significantly when patients were assessed in non-interventional acute site compared to a PCI site which has important implications for service provision. A large-scale randomised control trial is warranted to guide best practice. Funding Acknowledgement Type of funding source: None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».