Early or Selective Invasive Strategy in Patients with Non-ST-segment Elevation Acute Coronary Syndrome According to the Risk Factors at Presentation? An Outcome Study.
Loading...
Date
2014-10
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Aims: Patients with acute coronary syndrome without ST segment elevation are a
heterogeneous group with respect to the risk of having a major adverse cardiac event
(MACE). History of diabetes mellitus (DM), chronic kidney disease (CKD) and elevated
GRACE risk score are all factors defining a higher risk of MACE. We aimed to compare
the outcome of patients with early vs selective invasive strategy according to the risk
factors at presentation.
Methodology: We enrolled 178 patients with unstable angina or non-ST elevation
myocardial infarction (UA/NSTEMI), 52 (29.2%) had DM, 32 (19.7%)-CKD, defined when
MDRD measured glomerular filtration rate (GFR) was <60ml/min/1.73m2 and 28 (15.7%)
had GRACE≥140. The study had two arms: an early invasive strategy one (coronary
arteriography and percutaneous coronary intervention within 24 hours after admission), and a selective invasive strategy arm (medical stabilization, with coronary arteriography
required only in case of angina recurrence and/or evidence of inducible myocardial
ischemia). Follow-up was 22.8±14 months.
Results: For the whole group MACE occurred less often and the event free period was
longer in the early invasive strategy group compared to selective invasive one (p=0.001).
Early invasive strategy in diabetic patients, those with CKD and with GRACE ≥140 was
associated with a reduced MACE rate (p=0.008, 0.016 and 0.006, respectively) and
longer time to MACE occurrence compared with the selective invasive strategy.
When we evaluated separately non-diabetics, patients with normal renal function and
those with GRACE <140 we found no significant difference in MACE rate between the
patients allocated to early invasive strategy and those assigned to selective invasive
strategy. Early invasive strategy, however, showed some advantage over the selective
one also in the subgroup analysis-the time to occurrence of MACE was prolonged in
patients with lower risk at presentation.
Conclusions: Early invasive strategy in UA/NSTEMI is associated with a reduced MACE
rate and longer event-free period compared with selective invasive strategy. This benefit
is clearly evident in higher risk subsets (patients with DM, CKD and GRACE ≥140).
Description
Keywords
Citation
Dimitrov Nikolay, Simova Iana, Boichev Boicho, Mateev Hristo. Early or Selective Invasive Strategy in Patients with Non-ST-segment Elevation Acute Coronary Syndrome According to the Risk Factors at Presentation? An Outcome Study. Cardiology and Angiology An International Journal. 2014 Oct-Dec: 2(4): 205-222.