Abstract 1515: Outcomes of Patients With Acute Coronary Syndromes and Prior Coronary Artery Bypass Grafting. Results From the Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE-IT-TIMI 22) and the Aggrastat to Zocor (A to Z) trials.
Background: Patients with prior coronary artery bypass graft surgery (CABG) who develop acute coronary syndromes (ACS) are at high risk for major adverse cardiac events. The benefits of intensive statin therapy, targeting an LDL cholesterol of < 70 mg/dL, in patients with ACS and prior CABG have not been well studied.
Methods: The effect of intensive vs. moderate statin therapy was assessed in patients with and without prior CABG participating in the Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE-IT TIMI 22) or the Aggrastat to Zocor (A to Z) trials.
Results: Six hundred and forty of the 8655 patients (7.4%) enrolled in PROVE IT-TIMI 22 or A to Z had undergone CABG prior to enrollment. Prior CABG patients were older, more likely to be men and had a higher TIMI risk score. After a median follow-up of 2 years, compared to patients without prior CABG, those with prior CABG had 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 to moderate statin therapy, intensive statin therapy decreased the combined endpoint of cardiovascular death, myocardial infarction, stoke, and readmission for an acute coronary syndrome (A to Z primary endpoint) to a similar extent in patients with and without prior CABG (Table⇓). The benefit of intensive statin therapy in prior CABG patients appeared to be due to a reduction in unstable angina requiring hospitalization, with no significant difference in the incidence of death, myocardial infarction, or coronary revascularization.
Conclusions: Compared to ACS patients without prior CABG, those with prior CABG have significantly higher risk for death and adverse cardiac events and appear to show similar benefit from intensive statin therapy.