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Almeida I, Chin J, Santos H, Santos M, Miranda H, Almeida S, Sousa C, Almeida L. Optimal timing of intervention in non-ST-elevation acute coronary syndromes without pre-treatment. Rev Port Cardiol 2022. [DOI: 10.1016/j.repc.2021.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Case BC, Yerasi C, Wang Y, Forrestal BJ, Hahm J, Dolman S, Weintraub WS, Waksman R. Admissions Rate and Timing of Revascularization in the United States in Patients With Non-ST-Elevation Myocardial Infarction. Am J Cardiol 2020; 134:24-31. [PMID: 32892989 DOI: 10.1016/j.amjcard.2020.08.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/28/2020] [Accepted: 08/03/2020] [Indexed: 01/04/2023]
Abstract
Clinical trials have shown improved outcomes with an early invasive approach for non-ST-elevation myocardial infarction (NSTEMI). However, real-world data on clinical characteristics and outcomes based on time to revascularization are lacking. We aimed to analyze NSTEMI rates, revascularization timing, and mortality using the 2016 Nationwide Readmissions Database. We identify patients who underwent diagnostic angiography and subsequently received either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Finally, revascularization timing and mortality rates (in-hospital and 30-day) were extracted. Our analysis included 748,463 weighted NSTEMI hospitalizations in 2016. Of these hospitalizations, 50.3% (376,695) involved diagnostic angiography, with 34.1% (255,199) revascularized. Of revascularized patients, 77.6% (197,945) underwent PCI and 22.4% (57,254) underwent CABG. Patients with more comorbidities tended to have more delayed revascularization. PCI was most commonly performed on the day of admission (32.9%; 65,155). This differs from CABG, which was most commonly performed on day 3 after admission (13.7%; 7,823). The in-hospital mortality rate increased after day 1 for PCI patients and after day 4 for CABG patients, whereas 30-day in-hospital mortality for both populations increased as revascularization was delayed. Our study shows that patients undergoing early revascularization differ from those undergoing later revascularization. Mortality is generally high with delayed revascularization, as these are sicker patients. Randomized clinical trials are needed to evaluate whether very early revascularization (<90 minutes) is associated with improved long-term outcomes in high-risk patients.
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Affiliation(s)
- Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Yanying Wang
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Brian J Forrestal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Joshua Hahm
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Sarahfaye Dolman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - William S Weintraub
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
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Bonello L, Laine M, Lemesle G. Letter by Bonello et al Regarding Article, "Early Versus Standard Care Invasive Examination and Treatment of Patients With Non-ST-Segment Elevation Acute Coronary Syndrome: VERDICT Randomized Controlled Trial". Circulation 2019; 139:e959-e960. [PMID: 31082298 DOI: 10.1161/circulationaha.118.037810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Laurent Bonello
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Régional et Universitaire de Lille, France (L.B., M.L.).,Faculté de Médecine de l'Université de Lille, France (L.B., M.L.).,Institut Pasteur de Lille, Unité INSERM UMR 1011, France (L.B., M.L.).,FACT (French Alliance for Cardiovascular Trials), Lille, France (L.B., M.L.)
| | - Marc Laine
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Régional et Universitaire de Lille, France (L.B., M.L.).,Faculté de Médecine de l'Université de Lille, France (L.B., M.L.).,Institut Pasteur de Lille, Unité INSERM UMR 1011, France (L.B., M.L.).,FACT (French Alliance for Cardiovascular Trials), Lille, France (L.B., M.L.)
| | - Gilles Lemesle
- Aix-Marseille Université, MARS Cardio, Mediterraneen Association for Research and Studies in Cardiology, INSERM UMR-S 1076, Vascular Research Center of Marseille, France (G.L.)
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Lemesle G, Laine M, Pankert M, Puymirat E, Cuisset T, Boueri Z, Maillard L, Armero S, Cayla G, Bali L, Motreff P, Peyre JP, Paganelli F, Kerbaul F, Roch A, Michelet P, Baumstarck K, Bonello L. Early versus delayed invasive strategy for intermediate- and high-risk acute coronary syndromes managed without P2Y 12 receptor inhibitor pretreatment: Design and rationale of the EARLY randomized trial. Clin Cardiol 2018; 41:5-12. [PMID: 29356001 DOI: 10.1002/clc.22852] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 01/23/2023] Open
Abstract
According to recent literature, pretreatment with a P2Y12 ADP receptor antagonist before coronary angiography appears no longer suitable in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) due to an unfavorable risk-benefit ratio. Optimal delay of the invasive strategy in this specific context is unknown. We hypothesize that without P2Y12 ADP receptor antagonist pretreatment, a very early invasive strategy may be beneficial. The EARLY trial (Early or Delayed Revascularization for Intermediate- and High-Risk Non-ST-Segment Elevation Acute Coronary Syndromes?) is a prospective, multicenter, randomized, controlled, open-label, 2-parallel-group study that plans to enroll 740 patients. Patients are eligible if the diagnosis of intermediate- or high-risk NSTE-ACS is made and an invasive strategy intended. Patients are randomized in a 1:1 ratio. In the control group, a delayed strategy is adopted, with the coronary angiography taking place between 12 and 72 hours after randomization. In the experimental group, a very early invasive strategy is performed within 2 hours. A loading dose of a P2Y12 ADP receptor antagonist is given at the time of intervention in both groups. Recruitment began in September 2016 (n = 558 patients as of October 2017). The primary endpoint is the composite of cardiovascular death and recurrent ischemic events at 1 month. The EARLY trial aims to demonstrate the superiority of a very early invasive strategy compared with a delayed strategy in intermediate- and high-risk NSTE-ACS patients managed without P2Y12 ADP receptor antagonist pretreatment.
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Affiliation(s)
- Gilles Lemesle
- USIC et Centre Hémodynamique, Institut Cœur Poumon, Centre Hospitalier Régional et Universitaire de Lille; Faculté de Médecine de l'Université de Lille; Institut Pasteur de Lille, Unité INSERM UMR 1011; and FACT (French Alliance for Cardiovascular Trials), Lille, F-59000, France
| | - Marc Laine
- Aix-Marseille Université, AP-HM, Unité INSERM 1076, Unité de Soins Intensifs Cardiologiques, Department of Cardiology, Hôpital Nord, Marseille, France.,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France
| | - Mathieu Pankert
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France.,Department of Cardiology, Centre Hospitalier Henri Duffaut, Avignon, France
| | - Etienne Puymirat
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris, France; Université Paris Descartes, INSERM U-970, Paris, France
| | - Thomas Cuisset
- Aix-Marseille Université, AP-HM, Unité INSERM 1062, Unité de Soins Intensifs Cardiologiques, Department of Cardiology, Hôpital Nord, Marseille, France
| | - Ziad Boueri
- Department of Cardiology, Centre Hospitalier de Bastia, France
| | - Luc Maillard
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France.,Department of Cardiology, Clinique Axium, Aix-en-Provence, France
| | - Sébastien Armero
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France.,Department of Cardiology, Hôpital Européen, Marseille, France
| | - Guillaume Cayla
- Department of Cardiology, Centre Hospitalier Universitaire de Nîmes, Université de Montpellier, Nîmes, France
| | - Laurent Bali
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France.,Department of Cardiology, Centre Hospitalier de Cannes, France
| | - Pascal Motreff
- Department of Cardiology, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Jean-Pascal Peyre
- Department of Cardiology, Hôpital Privé Beauregard, Marseille, France
| | - Franck Paganelli
- Aix-Marseille Université, AP-HM, Unité INSERM 1076, Unité de Soins Intensifs Cardiologiques, Department of Cardiology, Hôpital Nord, Marseille, France
| | - François Kerbaul
- Pole RUSH, Assistance-Publique Hôpitaux de Marseille, Marseille, France
| | - Antoine Roch
- Emergency Department, Hôpital Nord, Marseille, France
| | | | - Karine Baumstarck
- Unité d'Aide Méthodologique à la Recherche Clinique, EA 3279, Laboratoire de Santé Publique, Aix-Marseille Université, Marseille, France
| | - Laurent Bonello
- Aix-Marseille Université, AP-HM, Unité INSERM 1076, Unité de Soins Intensifs Cardiologiques, Department of Cardiology, Hôpital Nord, Marseille, France.,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France
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