Early revascularization and long-term mortality in high-risk patients with non-ST-elevation myocardial infarction. The CARDIOCHUS-HUSJ registry
Por:
Alvarez, B, Casas, C, Cordero, A, Gomez, A, Alvarez, A, Bermejo, R, Acuna, J, Sampedro, F and Juanatey, J
Publicada:
1 ene 2020
Categoría:
Cardiology and cardiovascular medicine
Resumen:
Introduction and objectives: This study sought to analyze the association of early coronary angiography with all-cause mortality and cardiovascular mortality in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) using a large contemporary cohort of patients with NSTEACS from 2 Spanish tertiary hospitals.
Methods: This retrospective observational study included 5673 consecutive NSTEACS patients from 2 Spanish hospitals between 2005 and 2016. We performed propensity score matching to obtain a well-balanced subset of patients with the same probability of undergoing an early strategy, resulting in 3780 patients. Survival analyses were performed by Cox regression models once proportional risk test were verified.
Results: Among the study participants, only 2087 patients (40.9%) underwent early invasive coronary angiography. The median follow-up was 59.0 months [interquartile range, 25.0-80.0 months]. All-cause mortality was 19.0%, cardiovascular mortality was 12.8%, and 51.1% patients experienced at least 1 major cardiovascular adverse event in the follow-up. After propensity score matching, the early strategy was associated with significantly lower mortality (hazard ratio: 0.79; 95% confidence interval 0.62-0.98) in high-risk NSTEACS patients. The early strategy showed a nonsignificant inverse tendency in patients with GRACE score < 140.
Conclusions: In high-risk (GRACE score >= 140) NSTEACS patients in a contemporary real-world registry, early coronary angiography (first 24 hours after hospital admission) may be associated with reduced all-cause mortality and cardiovascular mortality at long-term follow-up. (C) 2019 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
Filiaciones:
Alvarez, B:
Hosp Clin Univ Santiago, Dept Cardiol, Travesia Choupana S-N, La Coruna 15706, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc, Madrid, Spain
Casas, C:
Hosp Clin Univ Santiago, Dept Cardiol, Travesia Choupana S-N, La Coruna 15706, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc, Madrid, Spain
:
Ctr Invest Biomed Red Enfermedades Cardiovasc, Madrid, Spain
Hosp Univ San Juan, Dept Cardiol, Alicante, Spain
Gomez, A:
Hosp Clin Univ Santiago, Dept Cardiol, Travesia Choupana S-N, La Coruna 15706, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc, Madrid, Spain
Alvarez, A:
Hosp Clin Univ Santiago, Dept Cardiol, Travesia Choupana S-N, La Coruna 15706, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc, Madrid, Spain
Bermejo, R:
Hosp Clin Univ Santiago, Dept Cardiol, Travesia Choupana S-N, La Coruna 15706, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc, Madrid, Spain
Acuna, J:
Hosp Clin Univ Santiago, Dept Cardiol, Travesia Choupana S-N, La Coruna 15706, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc, Madrid, Spain
Sampedro, F:
Hosp Clin Univ Santiago, Dept Epidemiol, La Coruna, Spain
Juanatey, J:
Hosp Clin Univ Santiago, Dept Cardiol, Travesia Choupana S-N, La Coruna 15706, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc, Madrid, Spain
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