Abstract | BACKGROUND: METHODS: The ACUITY trial was a multicenter, prospective trial of patients with ACS treated with an early invasive strategy. Major adverse cardiac event ( MACE; defined as death, myocardial infarction [MI], and repeat revascularization) and stroke were compared at 30 days and 1 year between PCI and CABG in patients with significant stenosis of the pLAD undergoing revascularization. Postprocedural major bleeding was evaluated at 30 days. RESULTS: Among patients with a significant pLAD stenosis (n = 842), a total of 562 (66.7%) underwent PCI and 280 (33.3%) underwent CABG. Baseline characteristics, including age, sex, diabetes, and TIMI risk score, were well matched between groups; however, patients undergoing PCI were more likely to have had previous CABG (21.9% vs 6.4%; P<.001). Death, MI, MACE, and stroke rates did not differ between groups at 1 year. PCI patients had lower bleeding rates (8.1% vs 52.4%; P<.001) and blood product transfusion at 30 days (4.5% vs 41.3%; P<.001), but higher rates of unplanned revascularization at 1 year (12.7% vs 5.2%; P<.01). These results were consistent in patients with single vs multivessel disease and in diabetics vs non-diabetics. CONCLUSIONS: Among ACS patients with pLAD culprit lesions, an initial revascularization strategy of PCI compared with CABG yields similar 1-year death, MI, and MACE rates, although unplanned revascularization is more common after PCI.
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Authors | Marco G Mennuni, George D Dangas, Roxana Mehran, Yanai Ben-Gal, Ke Xu, Philippe Généreux, Sorin J Brener, Frederick Feit, A Michael Lincoff, E Magnus Ohman, Martial Hamon, Gregg W Stone |
Journal | The Journal of invasive cardiology
(J Invasive Cardiol)
Vol. 27
Issue 10
Pg. 468-73
(Oct 2015)
ISSN: 1557-2501 [Electronic] United States |
PMID | 26121708
(Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Topics |
- Acute Coronary Syndrome
(diagnosis, mortality, surgery)
- Aged
- Coronary Angiography
- Coronary Artery Bypass
(methods)
- Coronary Vessels
(diagnostic imaging, surgery)
- Female
- Follow-Up Studies
- Humans
- Incidence
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Percutaneous Coronary Intervention
(methods)
- Postoperative Complications
(epidemiology)
- Prospective Studies
- Risk Factors
- Survival Rate
(trends)
- Treatment Outcome
- United States
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