Abstract 19018: Variation in Treatment and Outcomes in ACS: Insights from the Alberta Contemporary Acute Coronary Syndrome Patients Invasive Treatment Strategy (COAPT) Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kevin R Bainey ◽  
Padma Kaul ◽  
Wei Liu ◽  
Collen Norris ◽  
Mouhieddin Traboulsi ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Artery Bypass ◽  
Treatment Strategies ◽  
Hospital Death ◽  
Study Cohort ◽  
Invasive Treatment ◽  
Invasive Strategy ◽  
Repeat Revascularization ◽  
Coronary Syndrome ◽  
One Year

Background: In a universal health care system, we examined variations in treatment strategies and clinical outcomes in a contemporary cohort of acute coronary syndrome (ACS) patients. Methods: Hospitalization claims of 15,264 patients with ACS between April 1, 2010 and March 2012 were deterministically linked to the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) angiographic database. We compared baseline characteristics and use of diagnostic and therapeutic procedures across 3 invasive sites. For patients who underwent an invasive strategy, we examined 1-year rates of death and repeat revascularization. Results: Of the study cohort, 14.3% were medically treated at 91 non-invasive hospitals without transfer to an invasive site and had a 9.3% rate of in-hospital death. The remaining patients were admitted or transferred to one of the three invasive sites (A 5935 pts [40.4% transfer]; B 3910 pts [47.1% transfer]; C 3243 pts [57.4% transfer]). The majority were treated with an invasive strategy: A 87.4%, B 88.9%, C 90.1%, p<0.001). Patient characteristics according to invasive site are reported below (Table). Most notable are the dissimilar rates of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) along with the different use of drug-eluting stents (DES). Mortality rates were similar (in-hospital and 1-year). However, significant differences in one-year repeat revascularization were observed. Conclusion: Results from this large contemporary Canadian study suggest variation in revascularization strategies exist resulting in differences in clinical outcome at one year. Further investigations are warranted to allow alignment of best practice and patient outcomes for patients with ACS.

Abstract 16600: Unraveling Outcomes in Medically Managed Patient With Acute Coronary Syndromes (ACS): The Alberta COntemporary Acute coronary syndrome Patients invasive Treatment Strategies (COAPT) Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Robert C Welsh ◽  
Kevin R Bainey ◽  
Colleen Norris ◽  
Merril Knudtson ◽  
Dean Traboulsi ◽  
...  
Keyword(s):  
Treatment Strategies ◽  
Hospital Death ◽  
Invasive Treatment ◽  
Real World Data ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Diverse Patient Population ◽  
Health Database ◽  
One Year ◽  
Prolonged Hospital

Objectives: Limited “real world” data exists on characteristics and outcomes of ACS patients managed without revascularization (REVASC). Accordingly, we assessed an inclusive cohort of ACS patients grouped by catheterization and REVASC status. Methods: ACS pts in Alberta, Canada (n=3.7M) were assessed using population health database linkages (April 2010 - March 2013) and categorized into 3 groups: no CATH, CATH no REVASC and CATH REVASC (excluding pts with previous CATH - 6 m or ACS - 3 m). Baseline characteristics, in-hospital death, one year death and readmission were compared (logistic regression modelling). Results: Of 14, 661 ACS pts, 20.6% were not referred for CATH, 17.7% had CATH no REVASC and 61.7% had CATH REVASC (table). The pts not referred for CATH pts were older had more comorbidities, less frequent STEMI and were more likely admitted to a non-CATH hospital. They had prolonged hospital stay and 11.9% in-hospital death; 4-fold higher comparing no CATH vs. REVASC (adjusted OR 4.37, 95% CI 3.4-5.6). After excluding pts with in-hospital death within 2 days from admission and/or non-obstructive CAD (n=712), pts not referred for CATH had a 3-fold risk of in-hospital death (OR 3.28, 95% CI 2.5-4.4). Compared to REVASC, CATH no REVASC did not have increased in-hospital death (OR 1.2, 95% CI 0.86 - 1.1), however if pts without obstructive CAD were excluded, CATH no REVASC had a trend for increased in-hospital death (OR 1.4, 95% CI 0.99 - 1.96). Cath no REVASC was associated with increased 1 yr death (adjusted OR 1.97 (1.54-2.5)). Conclusion: Patients with ACS managed medically represent a diverse patient population. Once receiving CATH, pts managed medically have similar risk of death as those receiving REVASC. However those not referred for CATH have multiple comorbidities, are more likely managed in non-cardiac CATH hospitals and have a marked increase in both of in-hospital and 1 year death and rehospitalizaiton.This substantial cohort deserves further investigation.

scholarly journals Acute coronary syndrome: treatment strategies (part 1)

2017 ◽  
Vol 8 (2) ◽  
pp. 74-80
Author(s):  
N. B Perepech
Keyword(s):  
Blood Flow ◽  
Acute Coronary Syndrome ◽  
Treatment Strategies ◽  
Antiplatelet Agents ◽  
Clinical Aspects ◽  
Percutaneous Coronary Interventions ◽  
Invasive Treatment ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Flow Through

Two cases of medical care for patients with acute coronary syndrome are discussed, in which conservative and invasive treatment strategies were applied. The clinical aspects of thrombolytic therapy and percutaneous coronary interventions, the use of antiplatelet agents and anticoagulants for the prevention of atherothrombotic events after the restoration of blood flow through the infarct-responsible coronary artery are considered.

scholarly journals Impact of previous coronary artery bypass grafting in patients presenting with an acute coronary syndrome: Current trends and clinical implications

2020 ◽  
Vol 9 (7) ◽  
pp. 731-740
Author(s):  
Joana M Ribeiro ◽  
Rogério Teixeira ◽  
Alexandrina Siserman ◽  
Luís Puga ◽  
João Lopes ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Coronary Syndrome ◽  
Current Trends ◽  
One Year

Background: Among patients presenting with an acute coronary syndrome, those with previous coronary artery bypass grafting are a particular subset. Aims: The purpose of this study was to investigate the prognostic impact of previous coronary artery bypass grafting in acute coronary syndrome patients and to identify the current trends in their clinical management. Methods: We performed a cohort analysis of patients prospectively enrolled in the Portuguese Registry of acute coronary syndrome between 2010–2019 with known previous coronary artery bypass grafting status. The co-primary endpoints were in-hospital and one-year mortality. Results: A total of 19,334 (962 coronary artery bypass grafting and 18,372 non-coronary artery bypass grafting) and 9402 (479 coronary artery bypass grafting and 8923 non-coronary artery bypass grafting) patients were included in the analyses of in-hospital and mid-term outcomes, respectively. Coronary artery bypass grafting patients were older and had a higher incidence of comorbidities. They were less likely to undergo invasive angiography (74.9 vs 84.6%, p<0.001), but were equally likely to receive dual antiplatelet therapy (91.0 vs 90.8%, p=0.823). In-hospital mortality was similar between groups (3.6 vs 3.4%, p=0.722). Unadjusted one-year mortality was higher in the coronary artery bypass grafting group (hazard ratio 1.48, 95% confidence interval 1.09–2.01, p=0.012), but similar in both groups after propensity-matching and multivariate analysis (hazard ratio 0.63, 95% confidence interval 0.37–1.09, p=0.098). Conclusions: Among patients with acute coronary syndrome, a previous history of coronary artery bypass grafting was associated with a high burden of comorbidities and a high-risk profile but was not an independent predictor of adverse events. Treatment decisions should be made on a case-by-case basis, and should not be based on previous coronary artery bypass grafting status alone.

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