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
Journal Title: Cardiology and Angiology: An International Journal - Year 2014, Vol 2, Issue 4
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).
Authors and Affiliations
Nikolay Dimitrov, Iana Simova, Boicho Boichev, Hristo Mateev
Keywords
Related Articles
- EP ID EP344115
- DOI 10.9734/CA/2014/10483
- Views 111
- Downloads 0
Effect of Short Systemic Intermittent Hypoxia on Systemic Hemodynamics Blunted in Cutaneous Microcirculation
Background: Hypoxic stimulus induces a homeostatic disruption to enhance physiological adaptation. Blood flow in the microcirculation plays an important role in maintaining healthy tissues by delivering oxygen. The cutan...
Right Atrial Myxoma Complicated by Pulmonary Thromboembolism: A Case Report and Review of Literature
Primary cardiac tumors are rare with myxoma being the most common benign cardiac tumor. They are usually sporadic, affecting left atrium and frequently occur in women. They are known to cause valvular obstruction, thromb...
Acute Rheumatic Fever among Primary School Students in Harari Region, Eastern Ethiopia
Background: In many developed countries, acute rheumatic fever is eradicated through strong health promotion and prevention efforts; yet, it continues to cause serious health problems in many developing countries includi...
Correlations between Anthropometrics and Electrocardiographic Variables in Japanese University Students: Investigation by Annual Health Screening
Aims: Anthropometrics provide important health and fitness indicators in University students and have potential impacts on electrocardiographic (ECG) abnormalities leading to cardiac events. However, the correlations bet...
Extensive Type A Aortic Dissection; from Internal Carotid Artery to Iliac Artery: A Case Report and Review of the Literature
Aortic dissection is defined as separation of the layers within the aortic wall. An acute aortic dissection is associated with high morbidity and mortality rates, indeed, many patients die before presentation to the emer...