Predictors of the use of the early invasive strategy in women with non-ST-elevation acute coronary syndrome
Por:
de Miguel-Balsa E, Baeza-Román A, Pino-Izquierdo K, Latour-Pérez J, Coves-Orts FJ, Alcoverro-Pedrola JM, Pavía-Pesquera MC, Felices-Abad F, Calvo-Embuena R and Grupo ARIAM-SEMICYUC
Publicada:
1 nov 2014
Categoría:
Critical Care and Intensive Care Medicine
Resumen:
Objective: To identify determinants associated to an early invasive strategy in women with acute coronary syndromes without ST elevation (NSTE-ACS).
Design: A retrospective cohort study was made. Crude and adjusted analysis of the performance of the early invasive strategy using logistic regression.
Setting: Coronary Units enrolled in 2010 - 2011 in the ARIAM-SEMICYUC registry.
Patients: A total of 440 women with NSTE-ACS were studied. Sixteen patients were excluded due to insufficient data, together with 58 patients subjected to elective coronary angiography (> 72h).
Variables analyzed: Demographic parameters, coronary risk factors, previous medication, comorbidity. Clinical, laboratory, hemodynamic and electrocardiographic data of the episode.
Results: Women treated conservatively were of older age, had oral anticoagulation, diabetes, previous coronary lesions, and heart failure (p < 0,005), increased baseline bleeding and ischemic risk (p = 0,05) and a higher heart rate upon admission (p < 0,05). After adjustment, only age > 80 years (OR 0,48, 95% CI 0,27 to 0,82, p = 0,009), known coronary lesions (OR 0,47, 95% CI 0,26-0,84, p = 0,011), and heart rate (OR 0,98, 95% CI 0,97-0,99, p = 0,003) were independently associated to conservative treatment. Smoking (OR 2.50, 95% CI 1.20 to 5.19, p = 0,013) and high-risk electrocardiogram (OR 2.96, 95% CI 1.72 to 4.97, p < 0,001) were associated to the early invasive strategy. The exclusion of early deaths (<24 h) did not alter these results.
Conclusions: In women with NSTE ACS, smoking and a high-risk electrocardiogram upon admission were independent factors associated to the early invasive strategy. Previous coronary Lesions, age > 80 years and increased heart rate were independent factors associated to conservative treatment. (C) 2012 Elsevier Espana, S.L.U. and SEMICYUC. All rights reserved.
Filiaciones:
:
Servicio de Medicina Intensiva, Hospital General Universitario de Elche, Elche, Alicante, España
:
Servicio de Medicina Intensiva, Hospital General Universitario de Elche, Elche, Alicante, España
:
Servicio de Medicina Intensiva, Hospital General Universitario de Elche, Elche, Alicante, España
:
Servicio de Medicina Intensiva, Hospital General Universitario de Elche, Elche, Alicante, España
:
Servicio de Medicina Intensiva, Hospital General Universitario de Elche, Elche, Alicante, España
Alcoverro-Pedrola JM:
Servicio de Medicina Intensiva, Hospital Sant Joan de Déu, Manresa, Barcelona, España
Pavía-Pesquera MC:
Servicio de Medicina Intensiva, Hospital San Pedro, Logroño, La Rioja, España
Felices-Abad F:
Servicio de Medicina Intensiva, Hospital Reina Sofía, Murcia, España
:
Servicio de Medicina Intensiva, Hospital de Sagunt, Sagunto, Valencia, España
Open Access
|