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9 Routine non-invasive vs invasive management in patients with prior CABG with a NSTE-ACS: a randomised controlled trial
  1. Matthew MY Lee1,2,3,4,5,
  2. Mark C Petrie1,2,5,
  3. Paul Rocchiccioli1,2,5,
  4. Joanne Simpson1,2,
  5. Colette Jackson1,2,
  6. Ammani Brown2,3,
  7. David Corcoran1,2,
  8. Kenneth Mangion1,2,
  9. Pio Cialdella1,
  10. Novalia Sidik1,2,
  11. Margaret McEntegart1,2,3,
  12. Aadil Shaukat1,2,5,
  13. Alan Rae1,2,5,
  14. Stuart Hood1,4,
  15. Eileen Peat1,4,
  16. Iain Findlay4,
  17. Clare Murphy4,
  18. Alistair Cormack4,
  19. Nikolay Bukov6,
  20. Kanarath Balachandran6,
  21. Ian Ford7,
  22. Olivia Wu8,
  23. Alex McConnachie7,
  24. Sarah Barry7,
  25. Colin Berry1,2,3,
  26. behalf of the CABG-ACS Investigators
  1. 1West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow
  2. 2Institute of Cardiovascular and Medical Sciences, University of Glasgow
  3. 3Western Infirmary, Glasgow
  4. 4Royal Alexandra Hospital, Paisley
  5. 5Glasgow Royal Infirmary, Glasgow
  6. 6Royal Blackburn Hospital, Blackburn
  7. 7Robertson Centre for Biostatistics, University of Glasgow, Glasgow
  8. 8Department of Health Economics and Health Technology Assessment, University of Glasgow


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.

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