CCU083: Trends in choice of management strategy for NSTE-ACS among patients with previous bypass surgery before and after the COVID-19 pandemic

Project lead:
Mohamed Mohamed, Barts Heart Centre/University College London & Krishnaraj Rathod/ Daniel Jones, Barts Heart Centre/Queen Mary University London

The COVID-19 pandemic has affected the way we deliver care for cardiology patients, especially those presenting with heart attacks. While the pandemic is now deemed to be over, its indirect effect in terms of disruption to services persists.

Patients with non-ST elevation acute coronary syndrome (NSTE-ACS), a type of heart attack where there is an incomplete blockage of heart arteries (coronary arteries), are typically treated with medications alone (i.e. medical therapy), stents (a metal mesh) or bypass open heart surgery. Among patients who have already undergone previous bypass surgery, the options are often limited to medical therapy or stents, with further bypass surgery being reserved for a very limited group of patients.

Certain factors favour medical therapy over stents in this patient group, including the complexity of the disease in their arteries, their overall fitness for the procedure and prognosis, and more commonly physician preference. However, there are limited data from randomised controlled trials to date to inform physicians on the best strategy for managing this patient group.

It is unclear how the choice of management in this prevalent patient group has changed over time, before and after the COVID-19 pandemic, commensurate with evolving evidence and guideline recommendations, and whether there are any disparities based on certain patient characteristics (e.g. age, ethnicity, or sex) or geography.

This study will systematically examine national trends in the choice of management of NSTE-ACS among patients with previous bypass surgery over a 12-year horizon, examining factors that favour either strategy (medical therapy vs. stents) and comparing outcomes between strategies.

The findings from this study are expected to provide physicians and cardiologists with important outcomes data from a national perspective to guide their decision-making with respect to patient groups that would benefit the most from either treatment strategy.