{"id":"8420c9b01a92","type":"article","url":"https://hartvaat.nl/2024/07/12/nste-acs-na-cabg-meta-analyse-van-behandelstrategieen/","title":"NSTE-ACS na CABG: meta-analyse van behandelstrategieën","title_en":"Non-ST-elevation acute coronary syndromes with previous coronary artery bypass grafting: a meta-analysis of invasive vs. conservative management.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehae245","source_url":"https://doi.org/10.1093/eurheartj/ehae245","authors":["Matthew Kelham","Rohan Vyas","Rohini Ramaseshan","Krishnaraj Rathod","Robbert J de Winter","Ruben W de Winter","Bjorn Bendz","Holger Thiele","Geir Hirlekar","Nuccia Morici","Aung Myat","Lampros K Michalis","Juan Sanchis","Vijay Kunadian","Colin Berry","Anthony Mathur","Daniel A Jones"],"significance":5,"published":"2024-07-12","source_date":"2024-07-12","image":"","kennis":[],"congress":"","summary_en":"A meta-analysis compared invasive versus conservative management of non-ST-elevation acute coronary syndromes in patients with previous coronary artery bypass grafting. Outcomes were worse than in native coronary disease, and the optimal strategy varies by individual patient characteristics.","created":"2026-07-03T10:31:02Z","updated":"2026-07-03T13:30:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse onderzocht de behandelstrategieën bij NSTE-ACS na eerdere CABG. De uitkomsten waren slechter dan bij natieve coronairen, en de optimale aanpak (invasief vs conservatief) verschilt per patiënt.","abstract_original":"BACKGROUND AND AIMS: A routine invasive strategy is recommended in the management of higher risk patients with non-ST-elevation acute coronary syndromes (NSTE-ACSs). However, patients with previous coronary artery bypass graft (CABG) surgery were excluded from key trials that informed these guidelines. Thus, the benefit of a routine invasive strategy is less certain in this specific subgroup. METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. A comprehensive search was performed of PubMed, EMBASE, Cochrane, and ClinicalTrials.gov. Eligible studies were RCTs of routine invasive vs. a conservative or selective invasive strategy in patients presenting with NSTE-ACS that included patients with previous CABG. Summary data were collected from the authors of each trial if not previously published. Outcomes assessed were all-cause mortality, cardiac mortality, myocardial infarction, and cardiac-related hospitalization. Using a random-effects model, risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. RESULTS: Summary data were obtained from 11 RCTs, including previously unpublished subgroup outcomes of nine trials, comprising 897 patients with previous CABG (477 routine invasive, 420 conservative/selective invasive) followed up for a weighted mean of 2.0 (range 0.5-10) years. A routine invasive strategy did not reduce all-cause mortality (RR 1.12, 95% CI 0.97-1.29), cardiac mortality (RR 1.05, 95% CI 0.70-1.58), myocardial infarction (RR 0.90, 95% CI 0.65-1.23), or cardiac-related hospitalization (RR 1.05, 95% CI 0.78-1.40). CONCLUSIONS: This is the first meta-analysis assessing the effect of a routine invasive strategy in patients with prior CABG who present with NSTE-ACS. The results confirm the under-representation of this patient group in RCTs of invasive management in NSTE-ACS and suggest that there is no benefit to a routine invasive strategy compared to a conservative approach with regard to major adverse cardiac events. These findings should be validated in an adequately powered RCT."}