# NSTE-ACS na CABG: meta-analyse van behandelstrategieën

*geplaatst 2024-07-12 · Algemeen · European heart journal · doi 10.1093/eurheartj/ehae245 · https://hartvaat.nl/2024/07/12/nste-acs-na-cabg-meta-analyse-van-behandelstrategieen/*

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.

## English: Non-ST-elevation acute coronary syndromes with previous coronary artery bypass grafting: a meta-analysis of invasive vs. conservative management.

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.

## Abstract (original, from the publication)

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 RESULTS: Summary data were obtained from 11 RCTs, including previously unpublished subgroup outcomes of nine trials, comprising 897 patients with previous CABG (477 routine invasive, 420 conservative/selective invasive) followed up for a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.

Auteurs: 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

---
Bron: European heart journal, https://doi.org/10.1093/eurheartj/ehae245. Bijgewerkt 2026-07-03T13:30:05Z. 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.