Conservatively managed patients with non-ST-segment elevation acute coronary syndrome are undertreated with indicated medicines
Por:
Candela E, Marín F, Miguel Rivera-Caravaca, J, Vicente Ibarra N, Carrillo N, Asuncion Esteve-Pastor, M, Lozano M, Macias M, Pernias V, Sandin M, Orenes-Piñero E, Quintana-Giner M, Hortelano I, Villamia B, Veliz A, Valdés M, Martinez J and Ruiz J
Publicada:
28 nov 2018
Resumen:
Introduction and aims
Patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) are often managed conservatively. Clinical practice guidelines recommend treating these patients with the same pharmacological drugs as those who receive invasive treatment. We analyze the use of new antiplatelet drugs (NADs) and other recommended treatments in people discharged following an NSTE-ACS according to the treatment strategy used, comparing the medium-term prognosis between groups.
Methods
Prospective observational multicenter registry study in 1717 patients discharged from hospital following an ACS; 1143 patients had experienced an NSTE-ACS. We analyzed groups receiving the following treatment: No cardiac catheterization (NO CATH): n = 134; 11.7%; Cardiac catheterization without revascularization (CATH-NO REVASC): n = 256; 22.4%; percutaneous coronary intervention (PCI): n = 629; 55.0%; and coronary artery bypass graft (CABG): n = 124; 10.8%. We assessed major adverse cardiovascular events (MACE), all-cause mortality, and hemorrhagic complications at one year.
Results
NO CATH was the oldest, had the most comorbidities, and was at the highest risk for ischemic and hemorrhagic events. Few patients who were not revascularized with PCI received NADs (NO CATH: 3.7%; CATH-NO REVASC: 10.6%; PCI: 43.2%; CABG: 3.2%; p<0.001). Non-revascularized patients also received fewer beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB), and statins (p<0.001). At one year, MACE incidence in NO CATH group was three times that of the other groups (30.1%, p<0.001), and all-cause mortality was also much higher (26.3%, p<0.001). There were no significant differences in hemorrhagic events. Belonging to NO CATH group was an independent predictor for MACE at one year in the multivariate analysis (HR 2.72, 95% CI 1.29-5.73; p = 0.008).
Conclusions
Despite current invasive management of NSTE-ACS, patients not receiving catheterization are at very high risk for under treatment with recommended drugs, including NADs. Their medium-term prognosis is poor, with high mortality. Patients treated with PCI receive better pharmacological management, with high use of NADs.
Filiaciones:
Candela E:
Hosp Gen Univ Alicante, Inst Invest Sanitaria & Biomed Alicante ISABIAL, Dept Cardiol, Alicante, Spain
Department of Cardiology, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario de Alicante, Alicante, Spain
Marín F:
Hosp Clin Univ Virgen de la Arrixaca, Dept Cardiol, IMIB Arrixaca CIBER CV, Murcia, Spain
Department of Cardiology, IMIB-Arrixaca CIBER-CV, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
Miguel Rivera-Caravaca, J:
Hosp Clin Univ Virgen de la Arrixaca, Dept Cardiol, IMIB Arrixaca CIBER CV, Murcia, Spain
:
Hosp Gen Univ Elche, Dept Cardiol, Alicante, Spain
Department of Cardiology, Hospital General Universitario de Elche, Alicante, Spain
Carrillo N:
Hosp Gen Univ Alicante, Inst Invest Sanitaria & Biomed Alicante ISABIAL, Dept Cardiol, Alicante, Spain
Department of Cardiology, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario de Alicante, Alicante, Spain
Asuncion Esteve-Pastor, M:
Hosp Clin Univ Virgen de la Arrixaca, Dept Cardiol, IMIB Arrixaca CIBER CV, Murcia, Spain
Lozano M:
Hosp Gen Univ Alicante, Inst Invest Sanitaria & Biomed Alicante ISABIAL, Dept Cardiol, Alicante, Spain
Department of Cardiology, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario de Alicante, Alicante, Spain
Macias M:
Hosp Gen Univ Alicante, Inst Invest Sanitaria & Biomed Alicante ISABIAL, Dept Cardiol, Alicante, Spain
:
Hosp Gen Univ Elche, Dept Cardiol, Alicante, Spain
Department of Cardiology, Hospital General Universitario de Elche, Alicante, Spain
Sandin M:
Hosp Gen Univ Alicante, Inst Invest Sanitaria & Biomed Alicante ISABIAL, Dept Cardiol, Alicante, Spain
Department of Cardiology, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario de Alicante, Alicante, Spain
Orenes-Piñero E:
Hosp Clin Univ Virgen de la Arrixaca, Dept Cardiol, IMIB Arrixaca CIBER CV, Murcia, Spain
Department of Cardiology, IMIB-Arrixaca CIBER-CV, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
Quintana-Giner M:
Hosp Clin Univ Virgen de la Arrixaca, Dept Cardiol, IMIB Arrixaca CIBER CV, Murcia, Spain
Department of Cardiology, IMIB-Arrixaca CIBER-CV, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
Hortelano I:
Hosp Gen Univ Alicante, Inst Invest Sanitaria & Biomed Alicante ISABIAL, Dept Cardiol, Alicante, Spain
Department of Cardiology, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario de Alicante, Alicante, Spain
Villamia B:
Hosp Gen Univ Alicante, Inst Invest Sanitaria & Biomed Alicante ISABIAL, Dept Cardiol, Alicante, Spain
Department of Cardiology, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario de Alicante, Alicante, Spain
Veliz A:
Hosp Clin Univ Virgen de la Arrixaca, Dept Cardiol, IMIB Arrixaca CIBER CV, Murcia, Spain
Department of Cardiology, IMIB-Arrixaca CIBER-CV, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
Valdés M:
Hosp Clin Univ Virgen de la Arrixaca, Dept Cardiol, IMIB Arrixaca CIBER CV, Murcia, Spain
Department of Cardiology, IMIB-Arrixaca CIBER-CV, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
Martinez J:
Hosp Gen Univ Alicante, Inst Invest Sanitaria & Biomed Alicante ISABIAL, Dept Cardiol, Alicante, Spain
Department of Cardiology, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario de Alicante, Alicante, Spain
Ruiz J:
Hosp Gen Univ Alicante, Inst Invest Sanitaria & Biomed Alicante ISABIAL, Dept Cardiol, Alicante, Spain
Department of Cardiology, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario de Alicante, Alicante, Spain
Green Published, Green Submitted, gold
|