Changes in Patterns of Coronary Revascularization Strategies for Patients With Acute Coronary Syndromes (from the CRUSADE Quality Improvement Initiative)

Gogo, Prospero; Dauerman, Harold L.; Mulgund, Jyotsna; Ohman, E. Magnus; Patel, Manesh R.; Cohen, David J.; Saucedo, Jorge; Harrington, Robert A.; Gibler, W. Brian; Smith, Sidney C.; Peterson, Eric D.; Roe, Matthew T.

doi:10.1016/j.amjcard.2006.12.037

Cited by 39 publications

(35 citation statements)

References 14 publications

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“…We observed greater utilization of PCI versus CABG in this patient population throughout the study period. Furthermore, consistent with previous cohort studies, 15,22,25 we observed that the choice of optimal revascularization strategy in this patient population is particularly influenced by the severity of underlying CAD. Among high-risk patients (3-vessel CAD and pLAD involvement), CABG has been the revascularization strategy of choice throughout the study period.…”

Section: Discussionsupporting

confidence: 77%

“…A previous study from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) Quality Improvement Initiative reported greater use of PCI as compared with CABG among NSTEMI patients with multivessel disease in the early 2000s. 15 However, contemporary trends in revascularization among the highrisk subset of participants with multivessel CAD and type 2 DM are not known. Accordingly, we used the National Cardiovascular Data Registry (NCDR) Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines (ACTION Registry-GWTG) database to study temporal trends and hospital-level variation in performance of CABG and PCI among DM patients with NSTEMI and angiography, demonstrating multivessel CAD.…”

mentioning

confidence: 99%

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Revascularization Trends in Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease Presenting With Non–ST Elevation Myocardial Infarction

Pandey

McGuire

Lemos

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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Background-Current guidelines recommend surgical revascularization (coronary artery bypass graft [CABG]) over percutaneous coronary intervention (PCI) in patients with diabetes mellitus and multivessel coronary artery disease. Few data are available describing revascularization patterns among these patients in the setting of non-ST-segment-elevation myocardial infarction. Methods and Results-Using Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines (ACTION Registry-GWTG), we compared the in-hospital use of different revascularization strategies (PCI versus CABG versus no revascularization) in diabetes mellitus patients with non-ST-segment-elevation myocardial infarction who had angiography, demonstrating multivessel coronary artery disease between July 2008 and December 2014. Factors associated with use of CABG versus PCI were identified using logistic multivariable regression analyses. A total of 29 769 patients from 539 hospitals were included in the study, of which 10 852 (36.4%) were treated with CABG, 13 760 (46.2%) were treated with PCI, and 5157 (17.3%) were treated without revascularization. The overall use of revascularization increased over the study period with an increase in the proportion undergoing PCI (45% to 48.9%; P trend =0.0002) and no change in the proportion undergoing CABG (36.1% to 34.7%; p trend =0.88). There was significant variability between participating hospitals in the use of PCI and CABG (range: 22%-100%; 0%-78%, respectively; P value <0.0001 for both). Patient-level, but not hospital-level, characteristics were statistically associated with the use of PCI versus CABG, including anatomic severity of the disease, early treatment of adenosine diphosphate receptor antagonists at presentation, older age, female sex, and history of heart failure. Conclusions-Among patients with diabetes mellitus and multivessel coronary artery disease presenting with non-ST-segment-elevation myocardial infarction, only one third undergo CABG during the index admission. Furthermore, the use of PCI, but not CABG, increased modestly over the past 6 years. (Circ Cardiovasc Qual Outcomes. 2016;9:197-205.

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Section: Discussionsupporting

confidence: 77%

mentioning

confidence: 99%

Revascularization Trends in Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease Presenting With Non–ST Elevation Myocardial Infarction

Pandey

McGuire

Lemos

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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“…14,15 In particular, several recent studies have documented that since the introduction of DES, the use of PCI to treat patients with multivessel coronary artery disease has increased, with a resulting decrease in rates of bypass surgery. 16,17 Although the precise explanation for this observation cannot be discerned from the present data, this trend most likely reflects the increased willingness of interventional cardiologists to perform PCI in patients with more complex disease whose risk of restenosis before the introduction of DES was thought to be prohibitive.…”

Section: Discussionmentioning

confidence: 47%

Temporal Changes in Coronary Revascularization Procedures, Outcomes, and Costs in the Bare-Metal Stent and Drug-Eluting Stent Eras

Ryan

Linde-Zwirble²,

Engelhart³

et al. 2009

Circulation

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“…It showed that, in low-risk patients undergoing isolated initial CABG between 1994 and 1999, there was an independent association between postoperative AFIB and increased mortality at 4 to 5 years. 6 Over the past decade, there has been a substantial shift toward the use of percutaneous coronary intervention for reperfusion, 13,14 reducing the "routine" operative CABG workload of cardiothoracic surgeons and transforming the operative list to include many older and higher-risk patients. 2 The increasing risk profile of the population receiving CABG 4 makes the rela-tionship between postoperative AFIB and survival of even greater interest.…”

mentioning

confidence: 99%

New-Onset Postoperative Atrial Fibrillation After Isolated Coronary Artery Bypass Graft Surgery and Long-Term Survival

Filardo

Hamilton

Hebeler

et al. 2009

Circ: Cardiovascular Quality and Outcomes

115

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Background-The advancing age and generally increasing risk profile of patients receiving isolated coronary artery bypass graft (CABG) surgery is expected to raise incidence of new-onset postoperative atrial fibrillation (AFIB) resulting in potentially higher risk of adverse outcomes. In the early postoperative course, new-onset post-CABG AFIB is considered relatively easy to treat and is believed to have little impact on patients' long-term outcome. However, little has been done to determine the effect of new-onset post-CABG AFIB on long-term survival, and this relationship is unclear. Methods and Results-Survival

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Changes in Patterns of Coronary Revascularization Strategies for Patients With Acute Coronary Syndromes (from the CRUSADE Quality Improvement Initiative)

Cited by 39 publications

References 14 publications

Revascularization Trends in Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease Presenting With Non–ST Elevation Myocardial Infarction

Revascularization Trends in Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease Presenting With Non–ST Elevation Myocardial Infarction

Temporal Changes in Coronary Revascularization Procedures, Outcomes, and Costs in the Bare-Metal Stent and Drug-Eluting Stent Eras

New-Onset Postoperative Atrial Fibrillation After Isolated Coronary Artery Bypass Graft Surgery and Long-Term Survival

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