Outcomes of patients with acute coronary syndromes and prior coronary artery bypass grafting
Results From the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) Trial
BACKGROUND: Patients with prior CABG with a subsequent non-ST-segment elevation acute coronary syndrome (ACS) pose an increasingly important clinical problem. Although GP IIb/IIIa inhibitors have improved the outcome of patients with ACS, their efficacy in patients with prior CABG has not been previously evaluated. Methods and Results- We analyzed the 30- and 180-day outcomes of patients with prior CABG enrolled in the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial. In this trial, which evaluated the efficacy of eptifibatide in patients with ACS, 1134 patients (12%) with prior CABG and 8321 without prior CABG were enrolled. After adjusting for differences in baseline characteristics and treatment, patients with prior CABG had a significantly higher mortality rates at 30 days (hazard ratio [HR], 1.45 [95% CI, 1.06 to 1.98]; P=0.019) and at 180 days (HR, 1.32 [95% CI, 1.04 to 1.67]; P=0.021). At 30 days, there was a similar effect on the primary end point of death or myocardial infarction in the eptifibatide group versus the placebo group in prior CABG patients (unadjusted HR, 0.90 [95% CI, 0.67 to 1.20]) and in patients without a history of CABG (unadjusted HR, 0.89 [95% CI, 0.80 to 0.99]). CONCLUSIONS: Patients with prior CABG with non-ST-segment elevation ACS have a significantly worse prognosis than do patients without a history of CABG. The treatment effect of eptifibatide in the prior CABG group was similar to the effect seen in patients without prior CABG.
|Keywords||*Coronary Artery Bypass, Acute Disease, Aged, Angina, Unstable/diagnosis/*drug therapy/mortality/surgery, Comparative Study, Coronary Disease/diagnosis/*drug therapy/mortality/surgery, Double-Blind Method, Endpoint Determination, Female, Humans, Incidence, Kinetics, Male, Middle aged, Myocardial Infarction/epidemiology, Peptides/*therapeutic use, Platelet Aggregation Inhibitors/*therapeutic use, Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors, Prognosis, Research Support, Non-U.S. Gov't, Survival Analysis, Syndrome, Treatment Outcome|
|Persistent URL||dx.doi.org/10.1161/hc0302.102578, hdl.handle.net/1765/9825|
Labinaz, M., Kilaru, R., Pieper, K.S., Marso, S.P., Kitt, M.M., Simoons, M.L., … Harrington, R.A.. (2002). Outcomes of patients with acute coronary syndromes and prior coronary artery bypass grafting. Circulation (Baltimore), 105(3), 322–327. doi:10.1161/hc0302.102578