TY - JOUR
T1 - Outcomes of Patients With Acute Coronary Syndrome and Previous Coronary Artery Bypass Grafting (from the Pravastatin or Atorvastatin Evaluation and Infection Therapy [PROVE IT-TIMI 22] and the Aggrastat to Zocor [A to Z] Trials)
AU - Brilakis, Emmanouil S
AU - de Lemos, James A
AU - Cannon, Christopher P.
AU - Wiviott, Stephen D.
AU - Murphy, Sabina A.
AU - Morrow, David A.
AU - Sabatine, Marc S.
AU - Banerjee, Subhash
AU - Blazing, Michael A.
AU - Califf, Robert M.
AU - Braunwald, Eugene
N1 - Funding Information:
Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis In Myocardial Infarction 22 was funded by Bristol-Myers Squibb Co. (Princeton, New Jersey) and Sankyo Pharma, Inc. (Parsippany, New Jersey) and Aggrastat to Zocor was funded by Merck & Co., Inc. (West Point, Pennsylvania). Dr. de Lemos has received research grant support from Merck & Co., Inc., and has served on speakers' bureaus for Merck & Co., Inc., Merck-Schering-Plough Corp. (Kenilworth, New Jersey), and Pfizer, Inc. (New York, New York). Dr. Cannon has received research grant support from Bristol-Myers Squibb Co., Sanofi-Aventis, Inc. (New York, New York), and Merck & Co., Inc., and consulting fees from AstraZeneca (Wilmington, Delaware), GlaxoSmithKline (Research Triangle Park, North Carolina), and Pfizer, Inc. Dr. Wiviott has received research support from Eli Lilly & Co. (Indianapolis, Indiana) and Sankyo Pharma, Inc., and honoraria for lectures from Pfizer, Inc. Dr. Murphy currently receives research grant support from AstraZeneca, Sanofi-Aventis, Inc., CV Therapeutics, Inc., Palo Alto, California, Eli Lilly & Co., Millennium, Cambridge, Massachussets, Schering-Plough Corp. (Kenilworth, New Jersey), Nuvelo, San Carlos, California, Pfizer, Inc., Inotek, Beverly, Massachussetts, and Merck & Co., Inc., and previously from Bristol-Myers Squibb Co. Dr. Morrow has received research grants and speaking honoraria from Sanofi-Aventis. Dr. Sabatine has served as consultant and on scientific advisory boards for Bristol-Myers Squibb Co. and Sanofi-Aventis. Dr. Blazing has received research grant support from Merck & Co., Inc., and Merck-Schering Plough and has served on speakers' bureaus for Pfizer, Inc., and Merck & Co., Inc. Dr. Califf has received major research grant support from and has had institutional relationships with Merck & Co., Inc., Schering-Plough Corp., Pfizer, Inc., Novartis Pharmaceuticals Corp. (East Hanover, New Jersey), and Bristol-Myers Squibb. Dr. Braunwald has received research support from Bristol-Myers Squibb Co., Merck & Co., Inc., and AstraZeneca and honoraria for lectures from Bristol-Myers Squibb Co., Sanofi-Aventis, Inc., and Pfizer, Inc.
PY - 2008/9/1
Y1 - 2008/9/1
N2 - We examined the effects of intensive statin therapy in patients with acute coronary syndromes (ACSs) and previous coronary artery bypass graft surgery (CABG) participating in the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction 22 (PROVE-IT TIMI 22) and the Aggrastat to Zocor (A to Z) trials. Of the 8,655 patients enrolled in PROVE IT-TIMI 22 or A to Z, 640 (7.4%) had undergone CABG before enrollment. After a median follow-up of 2 years, compared with patients without previous CABG, those with previous CABG had a higher risk of cardiovascular death (6.2% vs 2.8%), myocardial infarction (14.2% vs 6.6%), and readmission for ACS (7.9% vs 4.4%, p <0.001 for all comparisons) but a lower rate of repeat coronary revascularization (22.7% vs 26.9%, p = 0.01). Compared with moderate statin therapy, intensive statin therapy appeared to decrease the composite of cardiovascular death, myocardial infarction, stoke, and readmission for an ACS (A to Z primary end point) to a similar extent in patients with (26.1% vs 21.6%, hazard ratio 0.84, p = 0.27) and without (13.9% vs 12.0%, hazard ratio 0.86, p = 0.016) previous CABG, although the decrease was not statistically significant in the previous CABG group, likely due to the small number of patients with previous CABG. In conclusion, compared with patients with ACS without previous CABG, those with previous CABG have a higher risk for adverse cardiac events and may derive similar benefit from intensive statin therapy.
AB - We examined the effects of intensive statin therapy in patients with acute coronary syndromes (ACSs) and previous coronary artery bypass graft surgery (CABG) participating in the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction 22 (PROVE-IT TIMI 22) and the Aggrastat to Zocor (A to Z) trials. Of the 8,655 patients enrolled in PROVE IT-TIMI 22 or A to Z, 640 (7.4%) had undergone CABG before enrollment. After a median follow-up of 2 years, compared with patients without previous CABG, those with previous CABG had a higher risk of cardiovascular death (6.2% vs 2.8%), myocardial infarction (14.2% vs 6.6%), and readmission for ACS (7.9% vs 4.4%, p <0.001 for all comparisons) but a lower rate of repeat coronary revascularization (22.7% vs 26.9%, p = 0.01). Compared with moderate statin therapy, intensive statin therapy appeared to decrease the composite of cardiovascular death, myocardial infarction, stoke, and readmission for an ACS (A to Z primary end point) to a similar extent in patients with (26.1% vs 21.6%, hazard ratio 0.84, p = 0.27) and without (13.9% vs 12.0%, hazard ratio 0.86, p = 0.016) previous CABG, although the decrease was not statistically significant in the previous CABG group, likely due to the small number of patients with previous CABG. In conclusion, compared with patients with ACS without previous CABG, those with previous CABG have a higher risk for adverse cardiac events and may derive similar benefit from intensive statin therapy.
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UR - http://www.scopus.com/inward/citedby.url?scp=50949117228&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2008.04.024
DO - 10.1016/j.amjcard.2008.04.024
M3 - Article
C2 - 18721511
AN - SCOPUS:50949117228
SN - 0002-9149
VL - 102
SP - 552
EP - 558
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 5
ER -