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)

Emmanouil S Brilakis, James A de Lemos, Christopher P. Cannon, Stephen D. Wiviott, Sabina A. Murphy, David A. Morrow, Marc S. Sabatine, Subhash Banerjee, Michael A. Blazing, Robert M. Califf, Eugene Braunwald

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)552-558
Number of pages7
JournalAmerican Journal of Cardiology
Volume102
Issue number5
DOIs
StatePublished - Sep 1 2008

Fingerprint

tirofiban
Pravastatin
Simvastatin
Acute Coronary Syndrome
Coronary Artery Bypass
Transplants
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Infection
Therapeutics
Myocardial Infarction
Atorvastatin Calcium

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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). / Brilakis, Emmanouil S; de Lemos, James A; Cannon, Christopher P.; Wiviott, Stephen D.; Murphy, Sabina A.; Morrow, David A.; Sabatine, Marc S.; Banerjee, Subhash; Blazing, Michael A.; Califf, Robert M.; Braunwald, Eugene.

In: American Journal of Cardiology, Vol. 102, No. 5, 01.09.2008, p. 552-558.

Research output: Contribution to journalArticle

Brilakis, Emmanouil S ; de Lemos, James A ; Cannon, Christopher P. ; Wiviott, Stephen D. ; Murphy, Sabina A. ; Morrow, David A. ; Sabatine, Marc S. ; Banerjee, Subhash ; Blazing, Michael A. ; Califf, Robert M. ; Braunwald, Eugene. / 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). In: American Journal of Cardiology. 2008 ; Vol. 102, No. 5. pp. 552-558.
@article{995ec8134e4947a28e561acb1c469eb4,
title = "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)",
abstract = "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.",
author = "Brilakis, {Emmanouil S} and {de Lemos}, {James A} and Cannon, {Christopher P.} and Wiviott, {Stephen D.} and Murphy, {Sabina A.} and Morrow, {David A.} and Sabatine, {Marc S.} and Subhash Banerjee and Blazing, {Michael A.} and Califf, {Robert M.} and Eugene Braunwald",
year = "2008",
month = "9",
day = "1",
doi = "10.1016/j.amjcard.2008.04.024",
language = "English (US)",
volume = "102",
pages = "552--558",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "5",

}

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

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.

UR - http://www.scopus.com/inward/record.url?scp=50949117228&partnerID=8YFLogxK

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

VL - 102

SP - 552

EP - 558

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 5

ER -