RT Journal Article
SR Electronic
T1 9 Routine non-invasive vs invasive management in patients with prior CABG with a NSTE-ACS: a randomised controlled trial
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP A5
OP A6
DO 10.1136/heartjnl-2018-BCIS.9
VO 104
IS Suppl 1
A1 Lee, Matthew MY
A1 Petrie, Mark C
A1 Rocchiccioli, Paul
A1 Simpson, Joanne
A1 Jackson, Colette
A1 Brown, Ammani
A1 Corcoran, David
A1 Mangion, Kenneth
A1 Cialdella, Pio
A1 Sidik, Novalia
A1 McEntegart, Margaret
A1 Shaukat, Aadil
A1 Rae, Alan
A1 Hood, Stuart
A1 Peat, Eileen
A1 Findlay, Iain
A1 Murphy, Clare
A1 Cormack, Alistair
A1 Bukov, Nikolay
A1 Balachandran, Kanarath
A1 Ford, Ian
A1 Wu, Olivia
A1 McConnachie, Alex
A1 Barry, Sarah
A1 Berry, Colin
A1 behalf of the CABG-ACS Investigators
YR 2018
UL http://heart.bmj.com/content/104/Suppl_1/A5.2.abstract
AB 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.