Title

Predicting coronary artery bypass graft surgery in acute coronary syndromes

UMMS Affiliation

Center for Outcomes Research; Department of Medicine, Division of Cardiovascular Medicine

Date

2-1-2007

Document Type

Article

Medical Subject Headings

Acute Coronary Syndrome; Coronary Artery Bypass

Disciplines

Health Services Research

Abstract

Aims: To identify features predictive of hospital coronary artery bypass graft (CABG) surgery in patients with acute coronary syndromes (ACSs).

Methods and results: Data from 17,434 patients enrolled in an observational study were analysed. Patients in private hospitals were more likely to undergo CABG than those in public hospitals (10.3% vs. 6.9%, P<0.01); CABG was more frequent in the USA than in Europe (11.9 % vs 3.5%, P<0.01). Clinical features independently predictive of CABG on multivariable analysis included no previous CABG, male sex, history of angina, hypertension, hyperlipidaemia, or diabetes, no history of atrial fibrillation or congestive heart failure, ST depression in multiple territories, and absence of ST elevation. These factors were assigned a score to quantify the likelihood of CABG (c-statistic 0.69). This score was predictive regardless of ACS subgroup (c-statistic 0.65-0.71) and remained predictive across institutions regardless of the frequency with which CABG was performed. The score was of greatest clinical utility among hospitals performing CABG in >10% of their ACS patients.

Conclusions: Identifying ACS patients likely to undergo CABG using clinical features alone remains difficult. In hospitals with higher rates of surgical revascularisation, a subgroup of patients with an approximate 30% likelihood of CABG can be identified. Therapy in these patients can be tailored to minimise bleeding risk without compromising outcomes.

Rights and Permissions

Citation: EuroIntervention. 2007 Feb;2(4):452-8.

Related Resources

Link to Article in PubMed

PubMed ID

19755284