Abstract
Current American College of Cardiology/American Heart Association guidelines recommend loading clopidogrel >or=6 hours before percutaneous coronary intervention. Other American College of Cardiology guidelines advise withholding clopidogrel for 5 days before coronary artery bypass grafting (CABG) to avoid excessive bleeding. Previously published rules for predicting early CABG after coronary angiography (CA) were developed in selected patients with non-ST-segment elevation-acute coronary syndrome and not tested in community practice settings. Using logistic regression analysis we sought to develop an accurate decision rule to identify patients at higher risk for early CABG, in unselected community hospital patients undergoing diagnostic CA, who were candidates for percutaneous coronary intervention. The study was conducted at a community hospital in Ann Arbor, Michigan. A total of 986 randomly selected records from 2004 were reviewed. Sixty-two percent were men and mean age was 64 years. Twelve percent underwent CABG within 5 days of CA. Of those with previous CABG, only 2% underwent early CABG. From several potential predictor variables examined, age, male gender, previous CABG, history of typical angina pectoris, previous CA,...Continue Reading
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