Association of prior coronary artery bypass graft surgery with quality of care of patients with non-ST-segment elevation myocardial infarction: A report from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines

Michael S. Kim, Tracy Y. Wang, Fang-Shu Ou, Andrew J. Klein, Paul A. Hudson, John C. Messenger, Frederick A. Masoudi, John S. Rumsfeld, P. Michael Ho

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: The American College of Cardiology/American Health Association guidelines recommend both an early invasive strategy and administration of antiplatelet/anticoagulant therapy for high-risk patients in the absence of contraindications. Little is known about adherence to guideline recommendations in patients with prior coronary artery bypass graft (CABG) surgery presenting with non-ST-segment elevation myocardial infarction (NSTEMI). Methods: We analyzed 47,557 patients with NSTEMI in the 2007-2008 National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines. Treatment patterns were compared between patients with and without prior CABG surgery. Multivariable regression with generalized estimating equations evaluated the association between prior CABG and in-hospital outcomes. Results: In this study, 8,790 NSTEMI patients (18.5%) had a history of CABG surgery. Prior CABG surgery was associated with a significantly lower adjusted likelihood of early cardiac catheterization (adjusted odds ratio [OR] 0.88, 95% CI 0.83-0.92), higher rates of short-term clopidogrel use (adjusted OR 1.08, 95% CI 1.02-1.14), and comparable use of anticoagulant therapy (adjusted OR 0.96, 95% CI 0.88-1.04). Adjusted risks of bleeding and in-hospital mortality did not differ significantly between the 2 groups (adjusted ORs 1.00, 95% CI 0.92-1.11 and 0.99, 95% CI 0.87-1.11, respectively). Conclusions: Patients with prior CABG surgery presenting with NSTEMI are often felt to be at high risk for adverse outcomes and therefore require aggressive treatment. Our study indicates that they are less likely to undergo guideline-recommended early cardiac catheterization but equally or more likely to receive guideline-recommended antiplatelet and anticoagulant therapy. This risk-treatment paradox, however, does not appear to negatively influence short-term clinical outcomes.

Original languageEnglish (US)
Pages (from-to)951-957
Number of pages7
JournalAmerican Heart Journal
Volume160
Issue number5
DOIs
StatePublished - Nov 1 2010
Externally publishedYes

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Quality of Health Care
Coronary Artery Bypass
Registries
Guidelines
Transplants
Anticoagulants
clopidogrel
Odds Ratio
Cardiac Catheterization
Therapeutics
Guideline Adherence
Hospital Mortality
Non-ST Elevated Myocardial Infarction
Hemorrhage
Health

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association of prior coronary artery bypass graft surgery with quality of care of patients with non-ST-segment elevation myocardial infarction : A report from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines. / Kim, Michael S.; Wang, Tracy Y.; Ou, Fang-Shu; Klein, Andrew J.; Hudson, Paul A.; Messenger, John C.; Masoudi, Frederick A.; Rumsfeld, John S.; Ho, P. Michael.

In: American Heart Journal, Vol. 160, No. 5, 01.11.2010, p. 951-957.

Research output: Contribution to journalArticle

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abstract = "Background: The American College of Cardiology/American Health Association guidelines recommend both an early invasive strategy and administration of antiplatelet/anticoagulant therapy for high-risk patients in the absence of contraindications. Little is known about adherence to guideline recommendations in patients with prior coronary artery bypass graft (CABG) surgery presenting with non-ST-segment elevation myocardial infarction (NSTEMI). Methods: We analyzed 47,557 patients with NSTEMI in the 2007-2008 National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines. Treatment patterns were compared between patients with and without prior CABG surgery. Multivariable regression with generalized estimating equations evaluated the association between prior CABG and in-hospital outcomes. Results: In this study, 8,790 NSTEMI patients (18.5{\%}) had a history of CABG surgery. Prior CABG surgery was associated with a significantly lower adjusted likelihood of early cardiac catheterization (adjusted odds ratio [OR] 0.88, 95{\%} CI 0.83-0.92), higher rates of short-term clopidogrel use (adjusted OR 1.08, 95{\%} CI 1.02-1.14), and comparable use of anticoagulant therapy (adjusted OR 0.96, 95{\%} CI 0.88-1.04). Adjusted risks of bleeding and in-hospital mortality did not differ significantly between the 2 groups (adjusted ORs 1.00, 95{\%} CI 0.92-1.11 and 0.99, 95{\%} CI 0.87-1.11, respectively). Conclusions: Patients with prior CABG surgery presenting with NSTEMI are often felt to be at high risk for adverse outcomes and therefore require aggressive treatment. Our study indicates that they are less likely to undergo guideline-recommended early cardiac catheterization but equally or more likely to receive guideline-recommended antiplatelet and anticoagulant therapy. This risk-treatment paradox, however, does not appear to negatively influence short-term clinical outcomes.",
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T2 - A report from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines

AU - Kim, Michael S.

AU - Wang, Tracy Y.

AU - Ou, Fang-Shu

AU - Klein, Andrew J.

AU - Hudson, Paul A.

AU - Messenger, John C.

AU - Masoudi, Frederick A.

AU - Rumsfeld, John S.

AU - Ho, P. Michael

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