Prognostic benefit from an early invasive strategy in patients with non-ST elevation acute coronary syndrome (NSTEACS): evaluation of the new risk stratification in the NSTEACS European guidelines
Por:
Martinon-Martinez, J, Alvarez, B, Ferrero, T, Arias, F, Garcia, O, Antonio, C, Casas, C, Zuazola, P, Cordero, A, Escribano, D, Alvarez, B, Alvarez, D, Bermejo, R, Veloso, P, Acuna, J, Sampedro, F and Juanatey, J
Publicada:
1 sep 2021
Ahead of Print:
1 mar 2021
Resumen:
Objectives The objective of our work is to evaluate the prognostic benefit of an early invasive strategy in patients with high-risk NSTACS according to the recommendations of the 2020 clinical practice guidelines during long-term follow-up. Methods This retrospective observational study included 6454 consecutive NSTEACS patients. We analyze the effects of early coronary angiography (< 24 h) in patients with: (a) GRACE risk score > 140 and (b) patients with "established NSTEMI" (non ST-segment elevation myocardial infarction defined by an increase in troponins) or dynamic ST-T-segment changes with a GRACE risk score < 140. Results From 2003 to 2017, 6454 patients with "new high-risk NSTEACS" were admitted, and 6031 (93.45%) of these underwent coronary angiography. After inverse probability of treatment weighting, the long-term cumulative probability of being free of all-cause mortality, cardiovascular mortality and MACE differed significantly due to an early coronary intervention in patients with NSTEACS and GRACE > 140 [HR 0.62 (IC 95% 0.57-0.67), HR 0.62 (IC 95% 0.56-0.68), HR 0.57 (IC 95% 0.53-0.61), respectively]. In patients with NSTEACS and GRACE < 140 with established NSTEMI or ST/T-segment changes, the benefit of the early invasive strategy is only observed in the reduction of MACE [HR 0.62 (IC 95% 0.56-0.68)], but not for total mortality [HR 0.96 (IC 95% 0.78-1.2)] and cardiovascular mortality [HR 0.96 (IC 95% 0.75-1.24)]. Conclusions An early invasive management is associated with reduced all-cause mortality, cardiovascular mortality and MACE in NSTEACS with high GRACE risk score. However, this benefit is less evident in the subgroup of patients with a GRACE score < 140 with established NSTEMI or ST/T-segment changes.
Filiaciones:
Martinon-Martinez, J:
Complejo Hosp Univ Santiago de Compostela, Cardiol Dept, Rua Choupana S-N, Santiago De Compostela 15703, Spain
Alvarez, B:
Complejo Hosp Univ Santiago de Compostela, Cardiol Dept, Rua Choupana S-N, Santiago De Compostela 15703, Spain
Biomed Res Networking Ctr Cardiovasc Dis CIBERCV, Madrid, Spain
Ferrero, T:
Complejo Hosp Univ Santiago de Compostela, Cardiol Dept, Rua Choupana S-N, Santiago De Compostela 15703, Spain
Biomed Res Networking Ctr Cardiovasc Dis CIBERCV, Madrid, Spain
Arias, F:
Complejo Hosp Univ Santiago de Compostela, Cardiol Dept, Rua Choupana S-N, Santiago De Compostela 15703, Spain
Garcia, O:
Complejo Hosp Univ Santiago de Compostela, Cardiol Dept, Rua Choupana S-N, Santiago De Compostela 15703, Spain
Biomed Res Networking Ctr Cardiovasc Dis CIBERCV, Madrid, Spain
Antonio, C:
Complejo Hosp Univ Santiago de Compostela, Cardiol Dept, Rua Choupana S-N, Santiago De Compostela 15703, Spain
Biomed Res Networking Ctr Cardiovasc Dis CIBERCV, Madrid, Spain
Casas, C:
Complejo Hosp Univ Santiago de Compostela, Cardiol Dept, Rua Choupana S-N, Santiago De Compostela 15703, Spain
Biomed Res Networking Ctr Cardiovasc Dis CIBERCV, Madrid, Spain
:
Biomed Res Networking Ctr Cardiovasc Dis CIBERCV, Madrid, Spain
Univ Hosp San Juan, Cardiol Dept, Alicante, Spain
:
Biomed Res Networking Ctr Cardiovasc Dis CIBERCV, Madrid, Spain
Univ Hosp San Juan, Cardiol Dept, Alicante, Spain
:
Biomed Res Networking Ctr Cardiovasc Dis CIBERCV, Madrid, Spain
Univ Hosp San Juan, Cardiol Dept, Alicante, Spain
Alvarez, B:
Complejo Hosp Univ Santiago de Compostela, Cardiol Dept, Rua Choupana S-N, Santiago De Compostela 15703, Spain
Biomed Res Networking Ctr Cardiovasc Dis CIBERCV, Madrid, Spain
Alvarez, D:
Complejo Hosp Univ Santiago de Compostela, Cardiol Dept, Rua Choupana S-N, Santiago De Compostela 15703, Spain
Biomed Res Networking Ctr Cardiovasc Dis CIBERCV, Madrid, Spain
Bermejo, R:
Complejo Hosp Univ Santiago de Compostela, Cardiol Dept, Rua Choupana S-N, Santiago De Compostela 15703, Spain
Biomed Res Networking Ctr Cardiovasc Dis CIBERCV, Madrid, Spain
Veloso, P:
Complejo Hosp Univ Santiago de Compostela, Cardiol Dept, Rua Choupana S-N, Santiago De Compostela 15703, Spain
Biomed Res Networking Ctr Cardiovasc Dis CIBERCV, Madrid, Spain
Acuna, J:
Complejo Hosp Univ Santiago de Compostela, Cardiol Dept, Rua Choupana S-N, Santiago De Compostela 15703, Spain
Biomed Res Networking Ctr Cardiovasc Dis CIBERCV, Madrid, Spain
Sampedro, F:
Univ Clin Hosp Santiago de Compostela, Epidemiol Dept, Santiago De Compostela, Spain
Juanatey, J:
Complejo Hosp Univ Santiago de Compostela, Cardiol Dept, Rua Choupana S-N, Santiago De Compostela 15703, Spain
Biomed Res Networking Ctr Cardiovasc Dis CIBERCV, Madrid, Spain
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