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Bajraktari G, Elezi S, Bytyci I, Ibrahimi P, Abdyli G, Pllana-Pruthi E, Karahoda R, Batalli A, Poniku A, Shatri M, Gashi D, Bajraktari A, Shatri F, Henein MY. The Rationale and Design of the KOSovan Acute Coronary Syndrome (KOS-ACS) Registry. Diagnostics (Basel) 2024; 14:1486. [PMID: 39061623 PMCID: PMC11276365 DOI: 10.3390/diagnostics14141486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/23/2024] [Accepted: 04/23/2024] [Indexed: 07/28/2024] Open
Abstract
The KOSovan Acute Coronary Syndrome (KOS-ACS) Registry is established as a prospective, continuous, nationwide, web-based registry that is operated online. The KOS-ACS registry is designed with the following objectives: (1) to obtain data on the demographic, clinical, and laboratory characteristics of ACS patients treated in Kosovo; (2) to create a national database with information on health care in ACS patients treated in Kosovo; (3) to identify the national features of associations between ACS characteristics and clinical outcomes, including mortality, complications, the length of hospital stay, and the quality of clinical care; and (4) to propose a practical guide for improving the quality and efficiency of ACS treatment in Kosovo. The Kosovo Society of Cardiology and University of Prishtina will be responsible for the development of the KOS-ACS registry and centralized data analysis at the national level. The KOS-ACS Registry will enroll all patients admitted, at any of the registered clinical centers, with the diagnosis of ACS and who will be clinically managed at any of the Kosovo hospitals. Data on patient demographics, clinical characteristics, previous and hospital drug treatment, and reperfusion therapy will be collected. The type of ACS (unstable angina, NSTEMI, or STEMI) will also be clearly defined. The time from first medical contact to balloon inflation (FMC-to-balloon) and door-to-ballon time will be registered. In-hospital death and complications will be registered. Data on the post-hospital primary outcome (MACE: cardiac death, all-cause mortality, hospitalization, stroke, need for coronary revascularization) of patients, at 30 days and 1 year, will be included in the registry.
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Affiliation(s)
- Gani Bajraktari
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
- Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden;
| | - Shpend Elezi
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
- Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
| | - Ibadete Bytyci
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
- Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden;
| | - Pranvera Ibrahimi
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden;
| | - Genc Abdyli
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
| | - Edita Pllana-Pruthi
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
| | - Rona Karahoda
- Research Unit, Heimerer College, 10000 Prishtina, Kosovo;
| | - Arlind Batalli
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
- Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
| | - Afrim Poniku
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
- Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
| | - Mentor Shatri
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
| | - Drilon Gashi
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
| | - Artan Bajraktari
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
| | - Faik Shatri
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
| | - Michael Y. Henein
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden;
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Bonello L, Lemesle G. Timing of invasive coronary angiography in non-ST-elevation acute coronary syndrome: can we wait? EUROINTERVENTION 2024; 20:e735-e736. [PMID: 38887880 PMCID: PMC11163441 DOI: 10.4244/eij-d-23-01090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/23/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Laurent Bonello
- Soins intensifs de Cardiologie, Hôpital Universitaire Nord, Marseille, France
| | - Gilles Lemesle
- USIC, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
- Institut Pasteur de Lille, Inserm U1011, Lille, France
- FACT (French Alliance for Cardiovascular Trials), Paris, France
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3
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Lemesle G, Schurtz G, Verdier B, Bonello L. Very early invasive strategy in patients with non-ST-elevation myocardial infarction: should we go for it? Heart 2024; 110:461-462. [PMID: 38103914 DOI: 10.1136/heartjnl-2023-323688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Affiliation(s)
- Gilles Lemesle
- USIC et Centre Hemodynamique, Centre Hospitalier Universitaire de Lille, Institut Coeur Poumon, Lille, France
| | - Guillaume Schurtz
- Centre Hospitalier Universitaire de Lille, Institut Coeur Poumon, Lille, France
| | - Basile Verdier
- Centre Hospitalier Universitaire de Lille, Institut Coeur Poumon, Lille, France
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Marx N, Federici M, Schütt K, Müller-Wieland D, Ajjan RA, Antunes MJ, Christodorescu RM, Crawford C, Di Angelantonio E, Eliasson B, Espinola-Klein C, Fauchier L, Halle M, Herrington WG, Kautzky-Willer A, Lambrinou E, Lesiak M, Lettino M, McGuire DK, Mullens W, Rocca B, Sattar N. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J 2023; 44:4043-4140. [PMID: 37622663 DOI: 10.1093/eurheartj/ehad192] [Citation(s) in RCA: 210] [Impact Index Per Article: 210.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Sacco A, Montalto C, Bravi F, Ruzzenenti G, Garatti L, Oreglia JA, Bartorelli AL, Crimi G, LA Vecchia C, Savonitto S, Leonardi S, Oliva FG, Morici N. Non-ST-elevation acute coronary syndrome in chronic kidney disease: prognostic implication of an early invasive strategy. Minerva Cardiol Angiol 2023; 71:44-50. [PMID: 35212503 DOI: 10.23736/s2724-5683.21.05839-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The optimal timing of PCI for NSTE-ACS with CKD is unclear. The aim of our study was to assess whether early percutaneous coronary intervention (PCI) (within 24 hours from admission) is associated with improved in-hospital (mortality or acute kidney injury) and long-term events (composite of mortality, myocardial infarction, stroke and bleeding events) in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) with chronic kidney disease (CKD). METHODS We retrospectively studied NSTE-ACS patients who underwent PCI in large tertiary centers. CKD was defined as estimated glomerular filtration rate (eGFR)<60 mL/min/1.73 m2. A propensity score for the likelihood of an early invasive strategy was calculated. Relative risks (RR) and adjusted hazard ratios (HR) were estimated for in-hospital and follow-up events. RESULTS We included 821 patients, mean age was 69±12 years; 492 (60%) received an early PCI, and 273 (33%) had an eGFR <60. Median follow-up was 391 days. At univariate analysis, early treatment was associated with significantly lower in-hospital and follow-up events. However, after adjustment for major prognostic factors, there was no significant association with both in-hospital (RR=1.06; 95% CI 0.83-1.36) and follow-up events (RR=1.07; 95% CI 0.83-1.37). When the association was assessed in strata of CKD, lack of statistically significant association was confirmed, even if a trend emerged in patients with preserved renal function both on primary outcome (RR=0.47, 95% 0.18-1.22) and time to secondary outcome (HR=0.62, 95% CI 0.36-1.08). CONCLUSIONS In conclusion in a cohort of NSTE-ACS patients, an early invasive strategy does not independently affect prognosis.
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Affiliation(s)
- Alice Sacco
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy -
| | - Claudio Montalto
- University of Pavia and Coronary Care Unit, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy
| | - Francesca Bravi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giacomo Ruzzenenti
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Garatti
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Jacopo A Oreglia
- Interventional Cardiology Division, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino IRCCS, Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Gabriele Crimi
- Division of Cardiology, San Martino Hospital, Genoa, Italy
| | | | | | - Sergio Leonardi
- University of Pavia and Coronary Care Unit, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy
| | - Fabrizio G Oliva
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nuccia Morici
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Sethi R, Mohan L, Vishwakarma P, Singh A, Sharma S, Bhandari M, Shukla A, Sharma A, Chaudhary G, Pradhan A, Chandra S, Narain VS, Dwivedi SK. Feasibility and efficacy of delayed pharmacoinvasive therapy for ST-elevation myocardial infarction. World J Cardiol 2023; 15:23-32. [PMID: 36714366 PMCID: PMC9850672 DOI: 10.4330/wjc.v15.i1.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/14/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND ST-elevation myocardial infarction (STEMI) refers to a clinical syndrome that features symptoms of myocardial ischemia with consequent ST-elevation on electrocardiography and an associated rise in cardiac biomarkers. Rapid restoration of brisk flow in the coronary vasculature is critical in reducing mortality and morbidity. In patients with STEMI who could not receive primary percutaneous coronary intervention (PCI) on time, pharmacoinvasive strategy (thrombolysis followed by timely PCI within 3-24 h of its initiation) is an effective option.
AIM To analyze the role of delayed pharmacoinvasive strategy in the window period of 24-72 h after thrombolysis.
METHODS This was a physician-initiated, single-center prospective registry between January 2017 and July 2017 which enrolled 337 acute STEMI patients with partially occluded coronary arteries. Patients received routine pharmacoinvasive therapy (PCI within 3-24 h of thrombolysis) in one group and delayed pharmacoinvasive therapy (PCI within 24-72 h of thrombolysis) in another group. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) within 30 d of the procedure. The secondary endpoints included major bleeding as defined by Bleeding Academic Research Consortium classification, angina, and dyspnea within 30 d.
RESULTS The mean age in the two groups was comparable (55.1 ± 10.1 years vs 54.2 ± 10.5 years, P = 0.426). Diabetes was present among 20.2% and 22.1% of patients in the routine and delayed groups, respectively. Smoking rate was 54.6% and 55.8% in the routine and delayed groups, respectively. Thrombolysis was initiated within 6 h of onset of symptoms in both groups (P = 0.125). The mean time from thrombolysis to PCI in the routine and delayed groups was 16.9 ± 5.3 h and 44.1 ± 14.7 h, respectively. No significant difference was found for the occurrence of measured clinical outcomes in the two groups within 30 d (8.7% vs 12.9%, P = 0.152). Univariate analysis of demographic characteristics and risk factors for patients who reported MACCE in the two groups did not demonstrate any significant correlation. Secondary endpoints such as angina, dyspnea, and major bleeding were non-significantly different between the two groups.
CONCLUSION Delayed PCI pharmacoinvasive strategy in a critical diseased but not completely occluded artery beyond 24 h in patients who have been timely thrombolyzed seems a reasonable strategy.
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Affiliation(s)
- Rishi Sethi
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Lalit Mohan
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Pravesh Vishwakarma
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Abhishek Singh
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Swati Sharma
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Monika Bhandari
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Ayush Shukla
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Akhil Sharma
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Gaurav Chaudhary
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Sharad Chandra
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Varun Shankar Narain
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Sudhanshu Kumar Dwivedi
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
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Bae S, Cha JJ, Lim S, Kim JH, Joo HJ, Park JH, Hong SJ, Yu CW, Lim DS, Kim Y, Kang WC, Cho EJ, Lee SY, Kim SW, Shin ES, Hur SH, Oh SK, Lim SH, Kim HS, Hong YJ, Ahn Y, Jeong MH, Ahn TH. Early Invasive Strategy Based on the Time of Symptom Onset of Non-ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Interv 2023; 16:64-75. [PMID: 36599589 DOI: 10.1016/j.jcin.2022.09.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/12/2022] [Accepted: 09/20/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND A limitation of the current guidelines regarding the timing of invasive coronary angiography for patients with non-ST-segment elevation acute coronary syndrome is the randomization time. To date, no study has reported the clinical outcomes of invasive strategy timing on the basis of the time of symptom onset. OBJECTIVES The aim of this study was to investigate the effect of invasive strategy timing from the time of symptom onset on the 3-year clinical outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI). METHODS Among 13,104 patients from the Korea Acute Myocardial Infarction Registry-National Institutes of Health, 5,856 patients with NSTE myocardial infarction were evaluated. The patients were categorized according to symptom-to-catheter (StC) time (<48 or ≥48 hours). The primary outcome was 3-year all-cause mortality. RESULTS Overall, 3,919 patients (66.9%) were classified into the StC time <48 hours group. This group had lower all-cause mortality than the group with StC time ≥48 hours (7.3% vs 13.4%; P < 0.001). The lower risk for all-cause mortality in the group with StC time <48 hours group was consistent in all subgroups. Notably, emergency medical service use (HR: 0.31; 95% CI: 0.19-0.52) showed a lower risk for all-cause mortality than no emergency medical service use (HR: 0.54; 95% CI: 0.46-0.65; P value for interaction = 0.008). CONCLUSIONS An early invasive strategy on the basis of StC time was associated with a decreased risk for all-cause mortality in patients with NSTEMI. Because the study was based on a prospective registry, the results should be considered hypothesis generating, highlighting the need for further research. (iCReaT Study No. C110016).
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Affiliation(s)
- SungA Bae
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea; Department of Cardiology, Yongin Severance Hospital, Yonsei University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Jung-Joon Cha
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Subin Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ju Hyeon Kim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyung Joon Joo
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Hyoung Park
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Cheol Woong Yu
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Do-Sun Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yongcheol Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea; Department of Cardiology, Yongin Severance Hospital, Yonsei University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Woong Chol Kang
- Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Eun Jeong Cho
- Department of Cardiology, Heart and Brain Hospital, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, Republic of Korea
| | - Sang Yeub Lee
- Department of Cardiology, Heart and Brain Hospital, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, Republic of Korea
| | - Sang Wook Kim
- Department of Cardiology, Heart and Brain Hospital, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, Republic of Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan Medical Center, Ulsan, Republic of Korea
| | - Seung Ho Hur
- Department of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Seok Kyu Oh
- Department of Cardiology, Wonkwang University Hospital, Iksan, Republic of Korea
| | - Seong-Hoon Lim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Dankook University Hospital, Chungnam, Republic of Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Joon Hong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
| | - Tae Hoon Ahn
- Department of Cardiology, Heart and Brain Hospital, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, Republic of Korea.
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Han Y, Sun S, Qiao B, Liu H, Zhang C, Wang B, Wei S, Chen Y. Timing of angiography and outcomes in patients with non-ST-segment elevation myocardial infarction: Insights from the evaluation and management of patients with acute chest pain in China registry. Front Cardiovasc Med 2022; 9:1000554. [PMID: 36337879 PMCID: PMC9630349 DOI: 10.3389/fcvm.2022.1000554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Although an invasive strategy has been recommended within 24 h for patients with non-ST-segment elevation myocardial infarction (NSTEMI), the optimal timing of the invasive strategy remains controversial. We sought to investigate the association between the different timings of invasive strategies and clinical outcomes in patients with NSTEMI. Materials and methods Patients admitted with NSTEMI from the Evaluation and Management of Patients with Acute ChesT pain in China (EMPACT) registry between January 2016 and September 2017 were included. The primary outcomes were major adverse cardiac events (MACEs) within 30 days. Multivariable logistic regression was performed to assess independent risk factors for MACEs. Results A total of 969 patients with NSTEMI from the EMPACT Registry were eligible for this study. Coronary angiography (CAG) was performed in 501 patients [<24 h, n = 150 (15.5%); ≥ 24 h, n = 351 (36.2%)]. The rate of MACEs at 30 days in all patients was 9.2%, including 54 (5.6%) deaths. Patients who underwent CAG had a lower rate of MACEs and mortality than those who did not receive CAG (MACEs: 5.6% vs. 13.0%, P < 0.001; mortality: 1.6% vs. 9.8%, P < 0.001). Nonetheless, no statistically significant difference was found in the rates of MACEs and mortality between the early (< 24 h) and delayed (≥ 24 h) CAG groups. Older age (OR: 1.036, 95% CI: 1.007, 1.065, P = 0.014), and acute heart failure (OR: 2.431, 95% CI: 1.244, 4.749, P = 0.009) increased the risk of MACEs and protective factors were underwent CAG (OR: 0.427, 95% CI: 0.219, 0.832, P = 0.012) or PCI (OR: 0.376, 95% CI: 0.163, 0.868, P = 0.022). In the multilevel logistic regression, older age (OR: 0.944, 95% CI: 0.932, 0.957, P < 0.001), cardiogenic shock (OR: 0.233, 95% CI: 0.079, 0.629, P = 0.009), pulmonary moist rales (OR: 0.368, 95% CI: 0.197, 0.686, P = 0.002), and prior chronic kidney disease (OR: 0.070, 95% CI: 0.018, 0.273, P < 0.001) was negatively associated with CAG. Conclusion This real-world cohort study of NSTEMI patients confirmed that the early invasive strategy did not reduce the incidence of MACEs and mortality within 30 days compared with the delayed invasive strategy in NSTEMI patients.
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Affiliation(s)
- Yu Han
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Shukun Sun
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Bao Qiao
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Han Liu
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Chuanxin Zhang
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Bailu Wang
- Clinical Trial Center, Qilu Hospital of Shandong University, Jinan, China
| | - Shujian Wei
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- *Correspondence: Shujian Wei,
| | - Yuguo Chen
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Yuguo Chen,
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9
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Comparison of 3-Year Outcomes between Early and Delayed Invasive Strategies in Older and Younger Adults with Non-ST-Segment Elevation Myocardial Infarction Undergoing New-Generation Drug-Eluting Stent Implantation. J Clin Med 2022; 11:jcm11164780. [PMID: 36013019 PMCID: PMC9410439 DOI: 10.3390/jcm11164780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/01/2022] [Accepted: 08/13/2022] [Indexed: 11/17/2022] Open
Abstract
We evaluated the 3-year clinical outcomes of early invasive (EI) and delayed invasive (DI) strategies in older and younger adults with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing successful new-generation drug-eluting stent (DES) implantation to reflect current real-world practice. Overall, 4513 patients with NSTEMI were recruited from the Korea Acute Myocardial Infarction Registry-National Institute of Health and divided into two groups according to age: group A (age ≥ 65 years, n = 2253) and group B (age < 65 years, n = 2260). These two groups were further divided into two subgroups: group EI (A1 and B1) and DI (A2 and B2). The primary clinical outcome was the occurrence of major adverse cardiac and cerebrovascular events (MACCEs), defined as all-cause death, recurrent MI (re-MI), any repeat coronary revascularization, or stroke. The secondary clinical outcome was definite or probable stent thrombosis (ST). In both groups A and B, after multivariable-adjusted and propensity score-adjusted analyses, MACCE (group A, p = 0.137 and p = 0.255, respectively; group B, p = 0.171 and p = 0.135, respectively), all-cause death, cardiac death (CD), non-CD, re-MI, any repeat revascularization, stroke, and ST rates were similar between the EI and DI groups. When including only those with complex lesions, the primary and secondary clinical outcomes were not significantly different between the EI and DI groups. In the era of new-generation DESs, major clinical outcomes were not significantly different between the EI and DI strategies in both older and younger adults with NSTEMI.
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10
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Demandt JPA, Koks A, Haest R, Heijmen E, Thijssen E, Otterspoor LC, van Veghel D, El Farissi M, Eerdekens R, Vervaat F, Pijls NHJ, Veer MVT, Tonino PAL, Dekker LRC, Vlaar PJ. Prehospital triage of patients with suspected non-ST-segment elevation acute coronary syndrome: Rationale and design of the TRIAGE-ACS study. Contemp Clin Trials 2022; 119:106854. [PMID: 35863696 DOI: 10.1016/j.cct.2022.106854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/01/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) are currently transported and admitted to the nearest emergency department (ED) for risk stratification, diagnostic workup and treatment. Although such patients with NSTE-ACS can benefit from direct transfer to a PCI center for early invasive treatment, no reliable prehospital triage tools are available. Recently, the PreHEART score has been validated in the PreHEART study for prehospital triage of patients with suspected NSTE-ACS. METHODS The primary objective of the TRIAGE-ACS study, a prospective cohort study, is to determine whether prehospital triage using the PreHEART score can significantly reduce time from first medical contact to final diagnostics and revascularization in patients in need of coronary revascularization. The first cohort (control cohort; n = 500) is observatory and is used as a reference group for the second cohort. In the second cohort (interventional cohort; n = 500) patients are stratified in the ambulance for direct transfer to either a PCI or a non-PCI center, based on the PreHEART score. These two cohorts will be compared with each other. In total, 1000 patients will be included. Follow-up for endpoints will be performed by reviewing the medical record after 30 days, 1 year, and 2 years. CONCLUSION The TRIAGE-ACS study is the first prospective study to investigate the impact of prehospital triage using the PreHEART score on time to final invasive diagnostics and treatment in patients with NSTE-ACS in need of revascularization by transferring high risk patients directly to a PCI center and patients at a low risk of having an NSTE-ACS to a non-PCI center. Such triage strategy could potentially result in optimization of regional care for all ACS patients.
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Affiliation(s)
- Jesse P A Demandt
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands.
| | - Arjan Koks
- GGD Regional Ambulance Services, Eindhoven, the Netherlands
| | - Rutger Haest
- Department of Cardiology, St. Anna hospital, Geldrop, the Netherlands; Netherlands Heart Network (NHN), the Netherlands
| | - Eric Heijmen
- Department of Cardiology, Elkerliek Hospital, Helmond, the Netherlands; Netherlands Heart Network (NHN), the Netherlands
| | - Eric Thijssen
- Department of Cardiology, Maxima Medical Center, Veldhoven, the Netherlands; Netherlands Heart Network (NHN), the Netherlands
| | - Luuk C Otterspoor
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Dennis van Veghel
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands; Netherlands Heart Network (NHN), the Netherlands
| | - Mohamed El Farissi
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Rob Eerdekens
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Fabienne Vervaat
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Marcel V T Veer
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Lukas R C Dekker
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands; Netherlands Heart Network (NHN), the Netherlands
| | - Pieter J Vlaar
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
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11
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Kim YH, Her AY, Rha SW, Choi CU, Choi BG, Kim JB, Park S, Kang DO, Park JY, Park SH, Jeong MH. Outcomes of early versus delayed invasive strategy in older adults with non-ST-segment elevation myocardial infarction. Sci Rep 2022; 12:11429. [PMID: 35794207 PMCID: PMC9259558 DOI: 10.1038/s41598-022-15593-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/27/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractWe evaluated the 3-year clinical outcomes following early invasive (EI) and delayed invasive (DI) strategies in older adults with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing successful new-generation drug-eluting stents (DESs) implantation to reflect current real-world practice. Overall, 2437 older adults (age, ≥ 65 years) with NSTEMI were recruited from the Korea Acute Myocardial Infarction Registry-National Institute of Health. They were divided into two groups: EI (n = 1750) and DI (n = 687). The primary clinical outcome was the occurrence of major adverse cardiac and cerebrovascular events (MACCEs), defined by all-cause death, recurrent MI, any repeat coronary revascularization, and stroke. The secondary clinical outcome was stent thrombosis (ST). After multivariable-adjusted and propensity score-matched analyses, the primary and secondary clinical outcomes were not significantly different between the EI and DI groups. Even after the analysis was confined to those having complex lesions, these major clinical outcomes were similar between these two groups. The EI and DI strategies in older adults with NSTEMI receiving new-generation DES showed comparable results.Clinical Trial Registration: URL: http://cris.nih.go.kr/cris/en/; Unique identifier: KCT0000863.
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12
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Kite TA, Kurmani SA, Bountziouka V, Cooper NJ, Lock ST, Gale CP, Flather M, Curzen N, Banning AP, McCann GP, Ladwiniec A. Timing of invasive strategy in non-ST-elevation acute coronary syndrome: a meta-analysis of randomized controlled trials. Eur Heart J 2022; 43:3148-3161. [PMID: 35514079 PMCID: PMC9433309 DOI: 10.1093/eurheartj/ehac213] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 03/23/2022] [Accepted: 04/08/2022] [Indexed: 12/03/2022] Open
Abstract
Aims The optimal timing of an invasive strategy (IS) in non-ST-elevation acute coronary syndrome (NSTE-ACS) is controversial. Recent randomized controlled trials (RCTs) and long-term follow-up data have yet to be included in a contemporary meta-analysis. Methods and results A systematic review of RCTs that compared an early IS vs. delayed IS for NSTE-ACS was conducted by searching MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. A meta-analysis was performed by pooling relative risks (RRs) using a random-effects model. The primary outcome was all-cause mortality. Secondary outcomes included myocardial infarction (MI), recurrent ischaemia, admission for heart failure (HF), repeat re-vascularization, major bleeding, stroke, and length of hospital stay. This study was registered with PROSPERO (CRD42021246131). Seventeen RCTs with outcome data from 10 209 patients were included. No significant differences in risk for all-cause mortality [RR: 0.90, 95% confidence interval (CI): 0.78–1.04], MI (RR: 0.86, 95% CI: 0.63–1.16), admission for HF (RR: 0.66, 95% CI: 0.43–1.03), repeat re-vascularization (RR: 1.04, 95% CI: 0.88–1.23), major bleeding (RR: 0.86, 95% CI: 0.68–1.09), or stroke (RR: 0.95, 95% CI: 0.59–1.54) were observed. Recurrent ischaemia (RR: 0.57, 95% CI: 0.40–0.81) and length of stay (median difference: −22 h, 95% CI: −36.7 to −7.5 h) were reduced with an early IS. Conclusion In all-comers with NSTE-ACS, an early IS does not reduce all-cause mortality, MI, admission for HF, repeat re-vascularization, or increase major bleeding or stroke when compared with a delayed IS. Risk of recurrent ischaemia and length of stay are significantly reduced with an early IS.
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Affiliation(s)
- Thomas A Kite
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sameer A Kurmani
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Vasiliki Bountziouka
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Nicola J Cooper
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Selina T Lock
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Marcus Flather
- Norwich Medical School, University of East Anglia and Norfolk and Norwich University Hospital, Norwich, UK
| | - Nick Curzen
- University Hospital Southampton NHS Foundation Trust and School of Medicine, University of Southampton, Southampton, UK
| | - Adrian P Banning
- Department of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Andrew Ladwiniec
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
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13
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Keykhaei M, Ashraf H, Rashedi S, Farrokhpour H, Heidari B, Zokaei S, Bagheri S, Foroumadi R, Asgarian S, Amirian A, Saleh SK, James S. Differences in the 2020 ESC Versus 2015 ESC and 2014 ACC/AHA Guidelines on the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-Segment Elevation. Curr Atheroscler Rep 2021; 23:77. [PMID: 34671860 DOI: 10.1007/s11883-021-00976-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW We assessed the differences in the 2020 European Society of Cardiology (ESC) versus 2015 ESC and 2014 American College of Cardiology (ACC) guidelines on the management of non-ST-segment elevation acute coronary syndromes (NSTE-ACS). RECENT FINDINGS The recent publication of the 2020 ESC has provided a comprehensive series of recommendations on diagnosis and management of patients presenting with NSTE-ACS. However, there are discrepancies between the 2020 ESC versus 2015 ESC and 2014 ACC guidelines, creating uncertainty among clinicians in routine practices. Our investigation provides insights into several domains, including diagnosis, risk stratification, pharmacological treatments, invasive treatment, and special populations. Overall, it seems that the 2020 version of the ESC guideline for the management of NSTE-ACS provides the most evidence-based recommendations for clinicians; although due to the lack of validated investigation across some of the proposed recommendations, further longitudinal multicenter studies are warranted to address the current questions. Diagnostic algorithm in NSTE-ACS. ABBREVIATIONS ACC = American College of Cardiology; CABG = coronary artery bypass grafting; CCTA = coronary computed tomography angiography; CMR = cardiac magnetic resonance; CS = cardiogenic shock; ECG = electrocardiography; eGFR = estimated glomerular filtration rate; ESC = European Society of Cardiology; GRACE = Global Registry of Acute Coronary Events; HF = heart failure; LVEF = left ventricular ejection fraction; MPI = myocardial perfusion imaging; MR = mitral regurgitation; NSTE-ACS = non-ST-segment elevation acute coronary syndromes; PCI = percutaneous coronary intervention; TIMI = thrombolysis in myocardial infarction.
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Affiliation(s)
- Mohammad Keykhaei
- Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Haleh Ashraf
- Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Rashedi
- Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Farrokhpour
- Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Heidari
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Shaghayegh Zokaei
- Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sayna Bagheri
- Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Roham Foroumadi
- Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Asgarian
- Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Aslan Amirian
- Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrokh Karbalai Saleh
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Hasan Abad Sq, 11367-46911, Tehran, Iran.
| | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds Väg 38, 256, SE-751 05, 751 85, Uppsala, Sweden.
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14
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Murrone A, di Uccio FS, Amodeo V, Aspromonte N, Caldarola P, Casella G, Cipriani M, De Luca L, Di Lenarda A, Domenicucci S, Francese GM, Imazio M, Roncon L, Urbinati S, Valente S, Di Pasquale G, Gulizia MM, Colivicchi F, Gabrielli D. ANMCO POSITION PAPER: Timing of coronary angiography in non-ST-segment elevation acute coronary syndromes. Eur Heart J Suppl 2021; 23:C196-C203. [PMID: 34456646 PMCID: PMC8388606 DOI: 10.1093/eurheartj/suab068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
The European Society of Cardiology guidelines on non-ST-elevation acute coronary syndromes suggest different temporal strategies for the angiographic study depending on the risk profile. The scientific evidence underlying the guideline recommendations and the critical issues currently existing in Italy, that often do not allow either an extended strategy of revascularization within 24 h or the application of the principle of the same day transfer from a spoke to a hub centre, are analysed. The position paper focuses, in particular, on the subgroup of patients with a defined diagnosis of non-ST-elevation myocardial infarction by proposing a timing of coronary angiography/revascularization that takes into account the available scientific evidence and the organizational possibilities of a considerable part of national cardiology services.
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Affiliation(s)
- Adriano Murrone
- Cardiology-ICU Department, Ospedali di Città di Castello e di Gubbio-Gualdo Tadino, AUSL Umbria 1, Via Guerriero Guerra, Perugia 06127, Italy
| | | | - Vincenzo Amodeo
- Cardiology-ICU Department, Ospedale Santa Maria degli Ungheresi, Polistena, RC, Italy
| | - Nadia Aspromonte
- Heart Failure Unit, Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | - Gianni Casella
- Cardiology Department, Ospedale Maggiore, Azienda USL di Bologna, Bologna, Italy
| | - Manlio Cipriani
- Cardiology 2-Cardiac Failure and Trasplantation Unit, Cardiotoracovascular Department “A. De Gasperis”, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Leonardo De Luca
- Cardiology Unit, Cardiotoracovascular Department, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Andrea Di Lenarda
- Cardiovascular and non Cardiovascolular, Cardiovascolular and Sports Medicine Department, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Trieste, Italy
| | | | - Giuseppina Maura Francese
- Cardiology Department, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Massimo Imazio
- Cardiology Department, P.O.U. Santa Maria della Misericordia, Udine, Italy
| | - Loris Roncon
- Cardiology Department, Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | - Stefano Urbinati
- Cardiology Department, Ospedale Bellaria, Azienda USL di Bologna, Bologna, Italy
| | - Serafina Valente
- Clinical-Surgical Cardiology and ICU Department, A.O.U. Senese, Ospedale Santa Maria alle Scotte, Siena, Italy
| | | | - Michele Massimo Gulizia
- Cardiology Department, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
- Fondazione per il Tuo cuore—Heart Care Foundation, Firenze, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma, Italy
| | - Domenico Gabrielli
- Cardiology Unit, Cardiotoracovascular Department, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
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15
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Fagel ND, Amoroso G, Rabbering T, Gescher F, Vink MA, Slagboom T, van der Schaaf RJ, Herrman JPR, Patterson MS, Vos NS, Verbeek EC, de Winter RJ, Riezebos RK. One-year mortality in NSTEMI patients is unaffected by timing of PCI within the first week of admission: Results of a real-world cohort analysis. Catheter Cardiovasc Interv 2021; 98:E661-E667. [PMID: 34263520 DOI: 10.1002/ccd.29873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/24/2021] [Accepted: 07/05/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We aimed to explore the impact of time to percutaneous coronary intervention (PCI) (T2P) on 1-year mortality in non-ST-elevation myocardial infarction (NSTEMI) patients. BACKGROUND The current guidelines recommend an early invasive strategy for NSTEMI patients. However, impact of an early invasive strategy on mortality is a matter of debate. For that reason, real world data are of great value to determine the optimal treatment window. METHODS This retrospective single center cohort study was performed in a high-volume PCI center in Amsterdam, The Netherlands. Intermediate- and high-risk NSTEMI patients undergoing PCI were included. The main discriminant was timing of PCI after admission (T2P), stratified according to different time windows (<24 h, 24-72 h, 72 h-7 days or >7 days). We analyzed 1-year mortality and the time distribution of overall survival. RESULTS In total, 848 patients treated between January 1, 2016 and January 1, 2018 were included in the analysis. T2P was <24 h in 145 patients, 24-72 h in 192 patients, 72 h-7 days in 275 patients, and >7 days in 236 patients. The mean GRACE-risk score was 127.1 (SD 28.7), 130.0 (33.1), 133.8 (32.1), and 148.7 (34.6) respectively, p = <0.001. After adjusting for confounders, 1-year mortality in patients with T2P <24 h did not significantly differ when compared with T2P 24-72 h (OR = 1.08; 95% CI = 0.33-3.51) and T2P 72 h-7 days (OR 1.72; 95% CI = 0.57-5.21) but was significantly higher in T2P >7 days (OR = 3.20; 95% CI = 1.06-9.68). CONCLUSIONS In an unselected cohort of patients with NSTEMI, treatment by PCI <24 h did not lead to improved survival as compared to aT2P <7 days strategy. Delay in PCI >7 days after admission resulted in worse outcome.
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Affiliation(s)
- Nick D Fagel
- Heart Center, OLVG Hospital, Amsterdam, Netherlands
| | | | | | | | | | - Ton Slagboom
- Heart Center, OLVG Hospital, Amsterdam, Netherlands
| | | | | | | | - Nicola S Vos
- Heart Center, OLVG Hospital, Amsterdam, Netherlands
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16
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Long-term clinical outcomes in patients with unstable angina undergoing percutaneous coronary interventions in a contemporary registry data from Poland. Coron Artery Dis 2021; 31:215-221. [PMID: 31821194 DOI: 10.1097/mca.0000000000000812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Both unstable angina and non-ST-segment elevation myocardial infarction (NSTEMI) are still classified together in non-ST-elevation acute coronary syndromes despite the fact they substantially differ in both clinical profile and prognosis. The aim of the present study was to evaluate contemporary clinical characteristics and outcomes of unstable angina patients after percutaneous coronary intervention (PCI) in comparison with stable angina and NSTEMI in Swietokrzyskie District of Poland in years 2015-2017. METHODS A total of 7187 patients after PCI from ORPKI Registry (38% with diagnosis of unstable angina) were included into the analysis. Impact of clinical presentation (unstable angina, stable angina, NSTEMI, STEMI) on three-year outcomes were determined. RESULTS Unstable angina patients were older than stable angina but younger than NSTEMI individuals. In unstable angina group, the percentage of previous myocardial infarction (MI), PCI or coronary artery bypass grafting (CABG) was the highest among all analyzed groups. In three-year observation, the risk of death as well as MI and MACE in unstable angina after PCI was higher than stable angina angina but considerably lower than in the NSTEMI group. Multivariate analysis confirmed that prognosis in NSTEMI was substantially worse in comparison with unstable angina [relative risk (RR) 1.365, 95% confidence interval (CI): 1.126-1.655, P = 0.0015]. On the contrary in unstable angina and stable angina patients, the impact of diagnosis on mortality risk was similar (RR 1.189, 95% CI: 0.932-1.518, P = 0.1620). Parallel results were observed in respect of MI and MACE. Independent predictors of death or MACE were: age, kidney disease, hypertension, diabetes, previous stroke or previous PCI. CONCLUSION Three-year prognosis in unstable angina was considerable better in comparison with NSTEMI. On the contrary, after adjustment for baseline differences, the outcomes (death, MI, MACE) in unstable angina and stable angina patients were comparable.
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17
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Affiliation(s)
- Jorge Sanz-Sánchez
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy.,Cardio Center, Humanitas Research Hospital IRCCS, Rozzano - Milan, Italy.,Interventional Cardiology Unit, La Fe University and Polytechnic Hospital, Valencia, Comunidad Valenciana, Spain.,Centro de Investigación Biomedica en Red (CIBERCV), Madrid, Spain
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy .,Cardio Center, Humanitas Research Hospital IRCCS, Rozzano - Milan, Italy
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18
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Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale CP, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis BS, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten FH, Sibbing D, Siontis GC. Guía ESC 2020 sobre el diagnóstico y tratamiento del síndrome coronario agudo sin elevación del segmento ST. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Kim YH, Her AY, Jeong MH, Kim BK, Hong SJ, Kim S, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. Two-Year Clinical Outcomes According to Pre-PCI TIMI Flow Grade and Reperfusion Timing in Non-STEMI After Newer-Generation Drug-Eluting Stents Implantation. Angiology 2021; 73:152-164. [PMID: 33960211 DOI: 10.1177/00033197211012537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The 2-year clinical outcomes according to pre-percutaneous coronary intervention (PCI) thrombolysis in myocardial infarction (TIMI) flow grade and reperfusion timing were investigated in patients with non-ST-segment elevation myocardial infarction (NSTEMI) who received newer-generation drug-eluting stents. A total of 7506 NSTEMI patients were divided into 2 groups: early (PCI ≤ 24 hours: n = 6398; pre-PCI TIMI 0/1 [n = 2729], pre-PCI TIMI 2/3 [n = 3669]) and delayed (PCI > 24 hours: n = 1108; pre-PCI TIMI 0/1 [n = 428], pre-PCI TIMI 2/3 [n = 680]) invasive groups. Major adverse cardiac events were defined as all-cause death, recurrent myocardial infarction, or any repeat revascularization. All-cause death (P = 0.005 and 0.009, respectively) and cardiac death (P = .003 and 0.046, respectively) were significantly higher in pre-PCI TIMI 0/1 patients than in pre-PCI TIMI 2/3 patients both in the early and delayed invasive groups. In pre-PCI TIMI 0/1 patients, all-cause death rate was significantly higher in the delayed group (P = .023). In pre-PCI TIMI 2/3 patients, the clinical end point was similar between the 2 groups. An early invasive strategy is preferred to a delayed invasive strategy in reducing all-cause death in patients with pre-PCI TIMI 0/1. However, in patients with pre-PCI TIMI 2/3, both treatment strategies are acceptable.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seunghwan Kim
- Division of Cardiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale CP, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis BS, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten FH, Sibbing D, Siontis GCM. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021; 42:1289-1367. [PMID: 32860058 DOI: 10.1093/eurheartj/ehaa575] [Citation(s) in RCA: 2695] [Impact Index Per Article: 898.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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21
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Martinón-Martínez J, Álvarez Álvarez B, González Ferrero T, García-Rodeja Arias F, Otero García Ó, Cacho Antonio C, Abou Jokh Casas C, Zuazola P, Cordero A, Escribano D, Cid Alvarez B, Iglesias Álvarez D, Agra Bermejo R, Rigueiro Veloso P, García Acuña JM, Gude Sampedro F, González Juanatey JR. Prognostic benefit from an early invasive strategy in patients with non-ST elevation acute coronary syndrome (NSTEACS): evaluation of the new risk stratification in the NSTEACS European guidelines. Clin Res Cardiol 2021; 110:1464-1472. [PMID: 33687519 DOI: 10.1007/s00392-021-01829-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/24/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective of our work is to evaluate the prognostic benefit of an early invasive strategy in patients with high-risk NSTACS according to the recommendations of the 2020 clinical practice guidelines during long-term follow-up. METHODS This retrospective observational study included 6454 consecutive NSTEACS patients. We analyze the effects of early coronary angiography (< 24 h) in patients with: (a) GRACE risk score > 140 and (b) patients with "established NSTEMI" (non ST-segment elevation myocardial infarction defined by an increase in troponins) or dynamic ST-T-segment changes with a GRACE risk score < 140. RESULTS From 2003 to 2017, 6454 patients with "new high-risk NSTEACS" were admitted, and 6031 (93.45%) of these underwent coronary angiography. After inverse probability of treatment weighting, the long-term cumulative probability of being free of all-cause mortality, cardiovascular mortality and MACE differed significantly due to an early coronary intervention in patients with NSTEACS and GRACE > 140 [HR 0.62 (IC 95% 0.57-0.67), HR 0.62 (IC 95% 0.56-0.68), HR 0.57 (IC 95% 0.53-0.61), respectively]. In patients with NSTEACS and GRACE < 140 with established NSTEMI or ST/T-segment changes, the benefit of the early invasive strategy is only observed in the reduction of MACE [HR 0.62 (IC 95% 0.56-0.68)], but not for total mortality [HR 0.96 (IC 95% 0.78-1.2)] and cardiovascular mortality [HR 0.96 (IC 95% 0.75-1.24)]. CONCLUSIONS An early invasive management is associated with reduced all-cause mortality, cardiovascular mortality and MACE in NSTEACS with high GRACE risk score. However, this benefit is less evident in the subgroup of patients with a GRACE score < 140 with established NSTEMI or ST/T-segment changes.
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Affiliation(s)
- Jesús Martinón-Martínez
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa da Choupana s/n. 15703, Santiago de Compostela, Spain.
| | - Belén Álvarez Álvarez
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa da Choupana s/n. 15703, Santiago de Compostela, Spain
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Teba González Ferrero
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa da Choupana s/n. 15703, Santiago de Compostela, Spain
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Federico García-Rodeja Arias
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa da Choupana s/n. 15703, Santiago de Compostela, Spain
| | - Óscar Otero García
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa da Choupana s/n. 15703, Santiago de Compostela, Spain
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Carla Cacho Antonio
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa da Choupana s/n. 15703, Santiago de Compostela, Spain
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Charigan Abou Jokh Casas
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa da Choupana s/n. 15703, Santiago de Compostela, Spain
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Pilar Zuazola
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain
- Cardiology Department, University Hospital of San Juan, Alicante, Spain
| | - Alberto Cordero
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain
- Cardiology Department, University Hospital of San Juan, Alicante, Spain
| | - David Escribano
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain
- Cardiology Department, University Hospital of San Juan, Alicante, Spain
| | - Belén Cid Alvarez
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa da Choupana s/n. 15703, Santiago de Compostela, Spain
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Diego Iglesias Álvarez
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa da Choupana s/n. 15703, Santiago de Compostela, Spain
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Rosa Agra Bermejo
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa da Choupana s/n. 15703, Santiago de Compostela, Spain
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Pedro Rigueiro Veloso
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa da Choupana s/n. 15703, Santiago de Compostela, Spain
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - José María García Acuña
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa da Choupana s/n. 15703, Santiago de Compostela, Spain
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Francisco Gude Sampedro
- Epidemiology Department, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Ramón González Juanatey
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa da Choupana s/n. 15703, Santiago de Compostela, Spain
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain
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Denktas AE. Ischemia-Guided Approach Versus Early Invasive Approach for NSTE-ACS: How Early Is Early? Curr Cardiol Rep 2021; 23:34. [PMID: 33666745 DOI: 10.1007/s11886-021-01462-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Non-ST segment elevation acute coronary syndromes (NSTE-ACS) account for 70% of the patients with ACS. Most NSTE-ACS patients receive invasive therapies. Despite improvements in the systems of care and interventional techniques, the mortality of NSTE-ACS patients remains high, and delays in the treatment of NSTE-ACS patients continue to be a problem. This paper aims to discuss the importance of timeliness of invasive strategy in the treatment of NSTE-ACS as well as the state-of-the-art approach to this critical health problem. RECENT FINDINGS The relatively recent guidelines and meta-analyses on the subject try to shed light on the issue of timing. The picture is now a little clearer, but still much remains to be answered. We know that the early invasive strategy at least is safe and improves recurrent ischemia and refractory angina as well as the length of stay, lowering the cost. In higher-risk patients, there is a benefit for a more aggressive approach. The definition of "early" in the early invasive strategy has evolved over the past decade and currently pertains to an invasive strategy performed within 12-24 h of presentation.
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Affiliation(s)
- Ali E Denktas
- Baylor College of Medicine, Houston, TX, USA. .,MEDVAMC, 2002 Holcombe Blvd., Mail Code 111B Cardiology, Houston, TX, 77030, USA.
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23
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Nadarajah R, Gale C. The management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: key points from the ESC 2020 Clinical Practice Guidelines for the general and emergency physician. Clin Med (Lond) 2021; 21:e206-e211. [PMID: 33762388 PMCID: PMC8002777 DOI: 10.7861/clinmed.2020-0879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There have been significant advances in the diagnosis and management of non-ST-segment elevation myocardial infarction over recent years, which has been reflected in an international decline in mortality rates. This article provides an overview of the 2020 European Society of Cardiology Clinical Practice Guidelines for the topic, concentrating on areas relevant to the general or emergency physician. The recommendations and underlying evidence basis are analysed in three key areas: diagnosis (the recommendation to use high sensitivity troponin and how to apply it), pathways (the recommendation to facilitate early invasive coronary angiography to improve outcomes and shorten hospital stays) and treatment (a paradigm shift in the use of early intensive platelet inhibition). Gaps in the evidence base are highlighted, including the optimal management strategy for older people and the antiplatelet regime to consider when angiography may be delayed.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK and Leeds General Infirmary, Leeds, UK
| | - Chris Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK and Leeds General Infirmary, Leeds, UK
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24
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Impact of Early (≤24 h) Versus Delayed (>24 h) Intervention in Patients With Non-ST Segment Elevation Myocardial Infarction: An Observational Study of 20,882 Patients From the London Heart Attack Group. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 22:3-7. [DOI: 10.1016/j.carrev.2020.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 12/30/2022]
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25
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Shneĭder IA, Tsoĭ VG, Fomenko MS. Early surgical myocardial revascularization as an effective method of treating patients with acute coronary syndrome. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2020; 26:120-131. [PMID: 33332314 DOI: 10.33529/angio2020425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND One of the main methods of treating patients with acute coronary syndrome (ACS) is percutaneous coronary intervention (PCI), however in patients with multivascular, abnormal, or technically complicated coronary lesions, early surgical myocardial revascularization is more promising. Despite modern development of surgical and interventional techniques, the application of one strategy for all patients with acute coronary syndrome is problematic and should be based on the heart team's decision and patient data. AIM The study was aimed at assessing the results of early surgical myocardial revascularization in patients with acute coronary syndrome. PATIENTS AND METHODS Retrospectively with continuous sampling the study included 342 patients who underwent surgical treatment of acute coronary syndrome at the Federal Centre of High Medical Technologies from January 1st, 2014 to December 31st, 2018. Myocardial revascularization using two internal thoracic arteries was performed in 220 (64.3%) cases. The mean age of the patients was 64.2±10.8 years. Prevailing in the study were men - 69.3%. The average number of affected vessels amounted to 3.1±0.9. Fifty-six (16.4%) patients had cardiogenic shock at the time of operation, with 9 (2.6%) patients diagnosed as having severe mitral insufficiency and 5 (1.5%) with interventricular septal defect. All patients were on antiplatelet therapy. RESULTS In-hospital mortality was 5.2% (18 patients). The mean time of operation amounted to 205.3±58.9 min, with that of artificial circulation to 57.9±13.2 min. Such complication as postoperative haemorrhage was observed in 20 cases (5.8%). The average volume of drainage losses amounted to 507.3±66.7 ml. The average length of stay in the ICU was 3.8±1.4 days, with that of hospital stay being 16.6±2.1 days. Twenty-seven (7.9%) patients after removal of drainages were diagnosed as having exudative pericarditis which resolved on the background of medicamentous therapy. CONCLUSION Early surgical myocardial revascularization in patients with acute coronary syndrome may be performed safely and effectively, and should be considered individually in each patient by the heart team.
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Affiliation(s)
- Iu A Shneĭder
- Federal Centre of High Medical Technologies, RF Ministry of Public Health, Kaliningrad, Russia
| | - V G Tsoĭ
- Federal Centre of High Medical Technologies, RF Ministry of Public Health, Kaliningrad, Russia
| | - M S Fomenko
- Federal Centre of High Medical Technologies, RF Ministry of Public Health, Kaliningrad, Russia
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26
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Variation in treatment strategy for non-ST segment elevation myocardial infarction: A multilevel methodological approach. Int J Cardiol 2020; 328:35-39. [PMID: 33278418 DOI: 10.1016/j.ijcard.2020.11.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/17/2020] [Accepted: 11/27/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Variations by hospital and region in the selection of an early invasive strategy (EIS) after non-ST-segment elevation myocardial infarction (NSTEMI) in patients with high-risk criteria are unknown. METHODS We evaluated the data of 7037 patients with NSTEMI from 20 hospitals of 3 regions from the Korean Acute Myocardial Infarction Registry-National Institute of Health database. We used hierarchical generalized linear mixed-models to estimate region- and hospital-level variation in the selection of an EIS after adjusting for patient-level high-risk criteria. We explored the variation using the median rate ratio (MRR), which estimates the relative difference in the risk ratios of two hypothetically identical patients at two different sites. RESULTS An EIS was selected in 84.4% of patients. At the hospital level, the median selection rate was 80.4%. At the region level, the median selection rate was 74.9% in the east region, 81.3% in the north region, and 83.9% in the west region, respectively. After adjusting for patient-level covariates, we found significant hospital- (MRR 2.19, 95% confidence interval [CI]: 1.74-3.03) and region-level (MRR 1.88, 95%CI: 1.26-5.44) variation in the selection of an EIS. Among patient-level factors, male sex, ongoing chest pain, history of coronary artery disease or acute heart failure, and GRACE risk score > 140 were independently associated with the selection of an EIS. CONCLUSIONS We observed significant hospital- and region-level variation in the selection of an EIS after NSTEMI in high-risk patients. Quality improvement efforts are required to standardize decision making and to improve clinical outcomes.
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Batchelor RJ, Dinh D, Brennan A, Wong N, Lefkovits J, Reid C, Duffy SJ, Chan W, Cox N, Liew D, Stub D. Relation of Timing of Percutaneous Coronary Intervention on Outcomes in Patients With Non-ST Segment Elevation Myocardial Infarction. Am J Cardiol 2020; 136:15-23. [PMID: 32946855 DOI: 10.1016/j.amjcard.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Abstract
International guidelines suggest revascularization within 24 hours in non-ST segment elevation myocardial infarction (NSTEMI). Within a large population cohort study, we aimed to explore clinical practice regarding timing targets for percutaneous coronary intervention (PCI) in NSTEMI. The Victorian Cardiac Outcomes Registry was established in 2013 as a state-wide clinical quality registry, pooling data from public and private PCI capable centers. Data were collected on 11,852 PCIs performed for NSTEMI from 2014 to 2018. Patients were divided into 3 groups by time of symptom onset to PCI (<24 hours; 24 to 72 hours; >72 hours). We performed multivariable logistic regression analysis conditional on several baseline covariates in investigating the impact of timing of PCI in NSTEMI on clinical outcomes. Patients who underwent PCI within 24 hours represented 18.4% (n = 2,178); 24 to 72 hours 45.8% (n = 5,434); >72 hours 35.8% (n = 4,240). Patients waiting longer for PCI were older (62.6 ± 12.2 vs 64.8 ± 12.6 vs 67.0 ± 12.7, p <0.001), more likely to be female (23.1% vs 24.2% vs 26.4%, p = 0.007), and have diabetes (18.6% vs 21.1% vs 27.1%, p <0.001). Multivariate logistic regression found that as compared with PCI <24 hours, PCI 24 to 72 hours and PCI >72 hours of symptom onset were associated with a decreased risk of 30-day mortality (odds ratio 0.55; 95% confidence interval 0.35 to 0.86, p = 0.008 and odds ratio 0.64; 95% confidence interval 0.35 to 1.01, p = 0.053, respectively). There was no significant difference in 30-day mortality between groups following exclusion of patients presenting with cardiogenic shock or out of hospital cardiac arrest requiring intubation. In conclusion, many registry patients undergo PCI outside the 24-hour window following NSTEMI. This delay is at odds with current guideline recommendations but does not appear to be associated with an increased mortality risk.
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Affiliation(s)
- Riley J Batchelor
- Department of Cardiology, Alfred Health, Melbourne, Australia; Monash University, Melbourne, Australia
| | - Diem Dinh
- Monash University, Melbourne, Australia
| | | | - Nathan Wong
- Department of Cardiology, Alfred Health, Melbourne, Australia
| | - Jeffrey Lefkovits
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Christopher Reid
- Monash University, Melbourne, Australia; Curtin University, Perth, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Health, Melbourne, Australia; Monash University, Melbourne, Australia
| | - William Chan
- Department of Cardiology, Alfred Health, Melbourne, Australia; Monash University, Melbourne, Australia; Department of Cardiology, Western Health, Melbourne, Australia
| | - Nicholas Cox
- Monash University, Melbourne, Australia; Department of Cardiology, Western Health, Melbourne, Australia
| | | | - Dion Stub
- Department of Cardiology, Alfred Health, Melbourne, Australia; Monash University, Melbourne, Australia; Department of Cardiology, Western Health, Melbourne, Australia.
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Li Y, Wang C, Nan Y, Zhao H, Cao Z, Du X, Wang K. Early invasive strategy for non-ST elevation acute coronary syndrome: a meta-analysis of randomized, controlled trials. J Int Med Res 2020; 48:300060520966500. [PMID: 33115315 PMCID: PMC7607294 DOI: 10.1177/0300060520966500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Patients with non-ST elevation acute coronary syndrome (NSTE-ACS) benefit from coronary intervention, but the optimal timing for an invasive strategy is not well defined. This study aimed to determine whether an early invasive strategy (<12 hours) is superior to a delayed invasive strategy. METHODS Twelve studies of nine randomized, controlled trials of 8586 patients were included. RESULTS There were no significant differences in all-cause death (risk ratio [95% confidence interval]) (0.90, [0.77-1.06), re-myocardial infarction (re-MI) (0.95 [0.70-1.29]), major bleeding (0.97 [0.77-1.23]), and refractory ischemia (0.74 [0.53-1.05]) when we compared use of early and delayed invasive strategies. Furthermore, analysis of the effect of the chosen strategy on high-risk patients showed that the rate of composite death or re-MI was significantly decreased in patients with either a Global Registry of Acute Coronary Events (GRACE) risk score >140 or with elevated troponin levels (risk ratio 0.82 [0.72-0.92]; risk ratio 0.84 [0.76-0.93], respectively). CONCLUSIONS This meta-analysis shows that an early angiographic strategy does not improve clinical outcome in patients with NSTE-ACS. An early invasive strategy might reduce the rate of composite death or re-MI in high-risk patients with GRACE risk scores >140 or elevated cardiac markers.
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Affiliation(s)
- Ying Li
- Department of Cardiology, Tianjin Fifth Central Hospital, Tianjin, China
| | - Cuancuan Wang
- Department of Cardiology, Tianjin Fifth Central Hospital, Tianjin, China
| | - Yue Nan
- Department of Cardiology, Tianjin Fifth Central Hospital, Tianjin, China
| | - Hui Zhao
- Department of Cardiology, Tianjin Fifth Central Hospital, Tianjin, China
| | - Zhongnan Cao
- Department of Cardiology, Tianjin Fifth Central Hospital, Tianjin, China
| | - Xinping Du
- Department of Cardiology, Tianjin Fifth Central Hospital, Tianjin, China
| | - Kuan Wang
- Department of Cardiology, Tianjin Fifth Central Hospital, Tianjin, China
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Temporal trends and predictors of time to coronary angiography following non-ST-elevation acute coronary syndrome in the USA. Coron Artery Dis 2020; 30:159-170. [PMID: 30676387 DOI: 10.1097/mca.0000000000000693] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study aims to investigate the temporal trends in utilization of invasive coronary angiography (CA) at different time points and changing profiles of patients undergoing CA following non-ST-elevation acute coronary syndrome (NSTEACS). We also describe the association between time to CA and in-hospital clinical outcomes. PATIENTS AND METHODS We queried the National Inpatient Sample to identify all admissions with a primary diagnosis of NSTEACS from 2004 to 2014. Patients were stratified into early (day 0, 1), intermediate (day 2) and late strategy (day≥3) according to time to CA. Multivariable logistic regression was used to investigate the association between time to CA and in-hospital mortality, major bleeding, stroke and Major Adverse Cardiac and Cerebrovascular Events. RESULTS A total of 4 380 827 records were identified with a diagnosis of NSTEACS, out of which 57.5% received CA. The proportion of patients undergoing early CA increased from 65.6 to 72.6%, whereas late CA commensurately declined from 19.6 to 13.5%. Patients receiving early CA were younger (age: 64 vs. 70 years), more likely to be male (63.7 vs. 55.3%) and of Caucasian ethnic background (68.7 vs. 64.7%) compared with late CA group. Similarly, Women, weekend admissions and African Americans remain less likely to receive early CA. In-hospital mortality was lowest in the intermediate group (odds ratio=0.30, 95% confidence interval: 0.28-0.33). CONCLUSION Use of early CA has increased in the management of NSTEACS; however, there remain significant disparities in utilization of an early invasive approach in women, African Americans, admission day and older patients in the USA.
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Gupta AK, Jneid H, Addison D, Ardehali H, Boehme AK, Borgaonkar S, Boulestreau R, Clerkin K, Delarche N, DeVon HA, Grumbach IM, Gutierrez J, Jones DA, Kapil V, Maniero C, Mentias A, Miller PS, Ng SM, Parekh JD, Sanchez RH, Sawicki KT, te Riele ASJM, Remme CA, London B. Current Perspectives on Coronavirus Disease 2019 and Cardiovascular Disease: A White Paper by the JAHA Editors. J Am Heart Assoc 2020; 9:e017013. [PMID: 32347144 PMCID: PMC7429024 DOI: 10.1161/jaha.120.017013] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) has infected more than 3.0 million people worldwide and killed more than 200,000 as of April 27, 2020. In this White Paper, we address the cardiovascular co-morbidities of COVID-19 infection; the diagnosis and treatment of standard cardiovascular conditions during the pandemic; and the diagnosis and treatment of the cardiovascular consequences of COVID-19 infection. In addition, we will also address various issues related to the safety of healthcare workers and the ethical issues related to patient care in this pandemic.
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Affiliation(s)
- Ajay K. Gupta
- William Harvey Research InstituteBarts and the London School of Medicine and DentistryQueen Mary University of LondonUnited Kingdom
- Barts BP Centre of ExcellenceBarts Heart CentreLondonUnited Kingdom
- Royal London and St Bartholomew’s HospitalBarts Health NHS TrustLondonUnited Kingdom
| | - Hani Jneid
- Division of CardiologyBaylor College of MedicineHoustonTX
| | - Daniel Addison
- Division of Cardiovascular MedicineDepartment of MedicineThe Ohio State UniversityColumbusOH
| | - Hossein Ardehali
- Feinberg Cardiovascular and Renal Research InstituteNorthwestern UniversityChicagoIL
| | - Amelia K. Boehme
- Department of NeurologyVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNY
- Department of EpidemiologyMailman School of Public HealthColumbia UniversityNew YorkNY
| | | | | | - Kevin Clerkin
- Division of CardiologyDepartment of MedicineVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNY
| | | | - Holli A. DeVon
- University of California, Los Angeles, School of NursingLos AngelesCA
| | - Isabella M. Grumbach
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of IowaCarver College of MedicineIowa CityIA
| | - Jose Gutierrez
- Department of NeurologyVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNY
| | - Daniel A. Jones
- William Harvey Research InstituteBarts and the London School of Medicine and DentistryQueen Mary University of LondonUnited Kingdom
- Royal London and St Bartholomew’s HospitalBarts Health NHS TrustLondonUnited Kingdom
| | - Vikas Kapil
- William Harvey Research InstituteBarts and the London School of Medicine and DentistryQueen Mary University of LondonUnited Kingdom
- Barts BP Centre of ExcellenceBarts Heart CentreLondonUnited Kingdom
| | - Carmela Maniero
- William Harvey Research InstituteBarts and the London School of Medicine and DentistryQueen Mary University of LondonUnited Kingdom
- Barts BP Centre of ExcellenceBarts Heart CentreLondonUnited Kingdom
| | - Amgad Mentias
- Division of CardiologyDepartment of Internal MedicineUniversity of IowaIowa CityIA
| | | | - Sher May Ng
- Royal London and St Bartholomew’s HospitalBarts Health NHS TrustLondonUnited Kingdom
| | - Jai D. Parekh
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of IowaCarver College of MedicineIowa CityIA
| | - Reynaldo H. Sanchez
- Division of Cardiovascular MedicineDepartment of MedicineThe Ohio State UniversityColumbusOH
| | - Konrad Teodor Sawicki
- Feinberg Cardiovascular and Renal Research InstituteNorthwestern UniversityChicagoIL
| | - Anneline S. J. M. te Riele
- Division of Heart and LungsDepartment of CardiologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Carol Ann Remme
- Department of Clinical and Experimental CardiologyHeart CentreAmsterdam UMCLocation Academic Medical CenterAmsterdamthe Netherlands
| | - Barry London
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of IowaCarver College of MedicineIowa CityIA
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Ferreiro JL. Pre-Treatment With Oral P2Y 12 Inhibitors in Non-ST-Segment Elevation Acute Coronary Syndromes: Does One Size Fit All? JACC Cardiovasc Interv 2020; 13:918-920. [PMID: 32327088 DOI: 10.1016/j.jcin.2020.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/25/2020] [Indexed: 11/18/2022]
Affiliation(s)
- José Luis Ferreiro
- Department of Cardiology, Hospital Universitario de Bellvitge - IDIBELL, CIBER-CV, L'Hospitalet de Llobregat, Barcelona, Spain.
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Lemesle G, Laine M, Pankert M, Boueri Z, Motreff P, Paganelli F, Baumstarck K, Roch A, Kerbaul F, Puymirat E, Bonello L. Optimal Timing of Intervention in NSTE-ACS Without Pre-Treatment. JACC Cardiovasc Interv 2020; 13:907-917. [DOI: 10.1016/j.jcin.2020.01.231] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 10/24/2022]
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Ha ET, Cohen M, Fields PJ, Van Daele J, Gaeta TJ. The Utility of Echocardiography for Non-ST-Segment Elevation Myocardial Infarction: A Retrospective Study. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479319886572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The objectives were to assess factors associated with a higher likelihood of predicting acute coronary atherothrombosis (ACA) in non-ST-segment elevation myocardial infarction (NSTEMI), evaluate the impact of adding echocardiographic data, and develop an algorithm that would reduce overutilization of emergent angiography. Methods: Data were retrospectively analyzed on a patient cohort presenting to an emergency department of an urban community hospital with NSTEMI from October 1, 2015, to July 31, 2018. The inclusion criterion was any adult patient with a first-time, primary diagnosis of NSTEMI without high-risk features. The main outcome variables were the presence of ACA on angiography. Results: Seventy-three patients with NSTEMI were included in this study. Logistic regression analysis identified the following independent variables useful for predicting ACA: age, wall motion abnormality on echo, and levels of low-density lipoprotein. The model’s overall fit was highly significant ( P = .0012). Conclusion: An integrative approach was demonstrated for the management of patients with NSTEMI presenting to the hospital. Although the positive predictive value of echo in predicting ACA was limited, when combined with demographic attributes and risk factors, it proved to be successful in determining the need for angiography in patients with NSTEMI.
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Affiliation(s)
- Edward T. Ha
- St. George’s University School of Medicine, Grenada, WI, USA
- Department of Internal Medicine, New York Presbyterian–Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Marc Cohen
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Paul J. Fields
- St. George’s University School of Medicine, Grenada, WI, USA
| | - Jessie Van Daele
- Department of Clinical Research, The Brooklyn Methodist Hospital, Brooklyn, Brooklyn, NY, USA
| | - Theodore J. Gaeta
- Department of Emergency Medicine, New York Presbyterian–Brooklyn Methodist Hospital, Brooklyn, NY, USA
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Zwart B, Ten Berg JM, van 't Hof AW, Tonino PAL, Appelman Y, Liem AH, Arslan F, Waltenberger J, Jukema JW, de Winter RJ, Damman P. Indications for an early invasive strategy in NSTE-ACS patients. Neth Heart J 2020; 28:131-135. [PMID: 31696408 PMCID: PMC7052080 DOI: 10.1007/s12471-019-01337-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
An early invasive strategy in patients who have acute coronary syndrome without ST-elevation (NSTE-ACS) can improve clinical outcome in high-risk subgroups. According to the current guidelines of the European Society of Cardiology (ESC), the majority of NSTE-ACS patients are classified as "high-risk". We propose to prioritise patients with a global registry of acute coronary events (GRACE) risk score >140 over patients with isolated troponin rise or electrocardiographic changes and a GRACE risk score <140. We also acknowledge that same-day transfer for all patients at a high risk is not necessary in the Netherlands since the majority of Dutch cardiology departments are equipped with a catheterisation laboratory where diagnostic coronary angiography is routinely performed in NSTE-ACS patients. Therefore, same-day transfer should be restricted to true high-risk patients (in addition to those NSTE-ACS patients with very high-risk (VHR) criteria) in centres without coronary angiography capabilities.
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Affiliation(s)
- B Zwart
- Department of Cardiology, Catharina ziekenhuis, Eindhoven, The Netherlands.
- Department of Cardiology, St. Antonius ziekenhuis, Nieuwegein, The Netherlands.
| | - J M Ten Berg
- Department of Cardiology, St. Antonius ziekenhuis, Nieuwegein, The Netherlands
| | - A W van 't Hof
- Department of Cardiology, Maastricht University Medical Center (UMC)+, Maastricht, The Netherlands
| | - P A L Tonino
- Department of Cardiology, Catharina ziekenhuis, Eindhoven, The Netherlands
| | - Y Appelman
- Department of Cardiology, Amsterdam University Medical Center, Location VU University Medical Center, Amsterdam, The Netherlands
| | - A H Liem
- Department of Cardiology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - F Arslan
- Department of Cardiology, St. Antonius ziekenhuis, Nieuwegein, The Netherlands
| | - J Waltenberger
- Department of Cardiovascular Medicine, Medical Faculty, University of Münster, Münster, Germany
| | - J W Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - R J de Winter
- Department of Cardiology, Amsterdam University Medical Center, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - P Damman
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
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35
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Rashid M, Curzen N, Kinnaird T, Lawson CA, Myint PK, Kontopantelis E, Mohamed MO, Shoaib A, Gale CP, Timmis A, Mamas MA. Baseline risk, timing of invasive strategy and guideline compliance in NSTEMI: Nationwide analysis from MINAP. Int J Cardiol 2020; 301:7-13. [DOI: 10.1016/j.ijcard.2019.11.146] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/24/2019] [Accepted: 11/26/2019] [Indexed: 01/09/2023]
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36
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Álvarez Álvarez B, Abou Jokh Casas C, Cordero A, Gómez ÁM, Álvarez ABC, Bermejo RA, Acuña JMG, Gude Sampedro F, Juanatey JRG. Coronariografía precoz y mortalidad a largo plazo en infarto agudo de miocardio de alto riesgo. Registro CARDIOCHUS-HUSJ. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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37
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Awan A, Ogunti R, Fatima U, Gonzalez H, Ganta N, Rizwan M, Mahajan A, Opoku-Asare I. Timing of Percutaneous Coronary Intervention in Non-ST Elevation Acute Coronary Syndrome - Meta-Analysis and Systematic Review of Literature. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:1398-1404. [PMID: 31761637 DOI: 10.1016/j.carrev.2019.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/18/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is the standard procedure of care for most patients with non-ST elevation acute coronary syndrome (NSTE-ACS). However, the timing of PCI remains unclear. We performed this meta-analysis with available randomized controlled trials (RCTs) to compare early versus late coronary intervention in patients with NSTE-ACS. METHOD A total of 13 RCTs were selected through PubMed/MEDLINE via OVID, EMBASE via OVID and Cochrane Central Register of Controlled Trials (inception to October 2018) search. Outcomes were analyzed using the relative risk (RR) and 95% CI. Pooled RRs were determined using M-H random-effects model, which can account for between study heterogeneity. RESULTS We included 13 RCTs with 11,972 patients were included. There were 7101 patients were randomized into early invasive group and 4871 in late invasive group. There was a significant decrease in myocardial infarction with long-term follow up in early invasive group compared to the delayed invasive group (RR 0.847 [95% CI 0.74-0.95], p = 0.009) with no difference in mortality between early and late invasive group (5.41% vs 6.49%, RR 0.882 [95% CI, 0.76-1.02]). On subgroup analysis, data was available from 6 RCTs for GRACE (Global Registry of Acute Coronary Events) score and 8 RCTs for elevated troponin. Early intervention led to decrease in adverse events in patients with elevated GRACE score > 140 (Mantel-Haenszel pooled RR 0.88 [95% CI 0.82-0.95], p-value 0.002) but no difference was seen in patients with elevated troponin. CONCLUSION It can be postulated from these results that early invasive strategy leads to decrease in myocardial infarction but without significant decrease in mortality. In patients with elevated GRACE score (>140), early intervention did show a trend towards decrease in major adverse cardiac events, whereas in patients with elevated troponin alone, similar association was not observed. However, adequately powered randomized controlled trial is necessary to validate these findings.
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Affiliation(s)
- Ahmad Awan
- Department of Cardiology, Howard University Hospital, Washington, DC, United States of America.
| | - Richard Ogunti
- Department of Internal Medicine, Howard University Hospital, Washington, DC, United States of America
| | - Urooj Fatima
- Department of Cardiology, Howard University Hospital, Washington, DC, United States of America
| | - Hilda Gonzalez
- Department of Cardiology, Howard University Hospital, Washington, DC, United States of America
| | - Nitheesha Ganta
- Department of Internal Medicine, Howard University Hospital, Washington, DC, United States of America
| | - Muhammad Rizwan
- Department of Internal Medicine, Howard University Hospital, Washington, DC, United States of America
| | - Ankit Mahajan
- Department of Cardiology, Howard University Hospital, Washington, DC, United States of America
| | - Isaac Opoku-Asare
- Department of Cardiology, Howard University Hospital, Washington, DC, United States of America
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38
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Trends in Death Rate 2009 to 2018 Following Percutaneous Coronary Intervention Stratified by Acuteness of Presentation. Am J Cardiol 2019; 124:1349-1356. [PMID: 31547993 DOI: 10.1016/j.amjcard.2019.07.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 11/23/2022]
Abstract
Percutaneous coronary intervention (PCI) has evolved dramatically, along with patient complexity. We studied trends in in-hospital mortality with changes in patient complexity over the last decade stratified by clinical presentation. The study population included all patients presenting to the cardiac catheterization lab between January 2009 and July 2018. Expected in-hospital mortality was calculated using the National Cardiovascular Data Registry CathPCI risk scoring system. Yearly mean in-hospital mortality rates (%) were plotted and smoothed by weighted least squares regression for each presentation: ST-elevation myocardial infarction (STEMI), non-ST-elevation acute coronary syndrome (NSTE-ACS), and stable ischemic coronary artery disease (SI CAD). The overall cohort included 13,732 patients who underwent PCI during the study period, of whom 2,142 were for STEMI, 2,836 for NSTE-ACS, and 8,754 for SI CAD. Indications for PCI have changed over time, with more PCIs being performed for NSTE-ACS and STEMI than for SI CAD. NSTE-ACS and STEMI patients had a steady decrease in in-hospital mortality over time compared with SI CAD patients. Overall observed mortality continues to decrease in NSTE-ACS patients, with reduction in the observed mortality rate within the STEMI population to below expected since 2013. Patient complexity has not changed significantly. These results may be attributed to improved patient selection coupled with optimal pharmacotherapy with more robust therapies during procedure and hospitalization.
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39
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Yoshida R, Ishii H, Morishima I, Tanaka A, Morita Y, Takagi K, Yoshioka N, Hirayama K, Iwakawa N, Tashiro H, Kojima H, Mitsuda T, Hitora Y, Furusawa K, Tsuboi H, Murohara T. Early versus delayed invasive strategy in patients with non-ST-elevation acute coronary syndrome and concomitant congestive heart failure. J Cardiol 2019; 74:320-327. [DOI: 10.1016/j.jjcc.2019.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/21/2019] [Accepted: 03/05/2019] [Indexed: 12/28/2022]
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40
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Prilutskaya YA, Dvoretski LI. The Strategy of Management Patients with non-ST Elevation Acute Coronary Syndrome. ACTA ACUST UNITED AC 2019; 59:40-51. [DOI: 10.18087/cardio.2019.9.n366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/26/2019] [Indexed: 11/18/2022]
Abstract
The review covers issues of epidemiology, diagnostics, management strategy, and treatment outcomes in patients with non-ST elevation acute coronary syndrome. Numerous factors affecting the choice of an invasive strategy are analyzed as well as its correspondence to existing recommendations of patient’s management. The stratification of risk of development of adverse coronary events, which is a part of the formation of a treatment strategy, is discussed.
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Affiliation(s)
- Yu. A. Prilutskaya
- Federal State Budgetary Institution "Clinical Hospital" Office of the President of the Russian Federation
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41
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Zhang MB, Guo C, Li M, Lv YH, Fan YD, Wang ZL. Comparison of early and delayed invasive strategies in short-medium term among patients with non-ST segment elevation acute coronary syndrome: A systematic review and meta-analysis. PLoS One 2019; 14:e0220847. [PMID: 31404097 PMCID: PMC6690510 DOI: 10.1371/journal.pone.0220847] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 07/24/2019] [Indexed: 12/22/2022] Open
Abstract
Background and objectives An invasive approach is recommended as the treatment of patients with non-ST elevated acute coronary syndromes (NSTE-ACS). However, it remains unclear that the optimal time of angiography and intervention for patients with NSTE-ACS at present. This study was designed to compare the effect of early and delayed invasive strategies on short-medium term prognosis in patients with those. Methods Pubmed, Cochrane Library and Embase were searched up to Dec-30-2018. Randomized clinical trials comparing an early versus a delayed invasive strategy in patients with NSTE-ACS were included. The primary endpoint (all-cause death and recurrent myocardial infarction) and secondary endpoint (major bleeding and recurrent revascularization), as well as composite endpoint were assessed by random or fixed effected meta-analysis with software RevMan 5.3 version after short-medium term follow up. Result A total of six randomized clinical trials involving 4,277 early or delayed invasive strategies patients with NSTE-ACS were included in the meta-analysis. Time to coronary angiography varied from 0.5 to 24 h in the early invasive strategy and from 18.6 to 72 h in the delayed invasive strategy. There was a statistical difference in the primary endpoint of all-cause death among patients with NSTE-ACS between early and delayed invasive strategies (4.6% vs 6%; OR:0.76; 95% CI:0.58 to 1.00; P = 0.05; I2 = 0%), but not for recurrent myocardial infarction (6.0% vs 6.3%; OR: 0.94; 95% CI: 0.55 to 1.61; P = 0.82; I2 = 60%). The major bleeding in patients with NSTE-ACS was similar between both invasive strategies (2.7% vs 3.1%; OR:0.88; 95% CI:0.59 to 1.31; P = 0.54; I2 = 0%). However, the composite endpoint in the early invasive strategy patients with NSTE-ACS was significantly lower than that of the delayed invasive strategy (10.9% vs 13.9%; OR:0.76; 95% CI:0.63 to 0.92; P = 0.006; I2 = 0%), and the recurrent revascularization between both strategies was just the opposite (8.7% vs 5.9%; OR:1.5; 95%CI:1.15 to 1.97; P = 0.003; I2 = 0%). Conclusion The systematic review and meta-analysis demonstrated that the early invasive strategy had a beneficial trend on all-cause death and significantly reduced the composite endpoint in patients with NSTE-ACS, but increased the rate of revascularization. These data could provide a solution for patients with those.
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Affiliation(s)
- Ming-Bo Zhang
- The First Medical Clinical College of Lanzhou University, Lanzhou, China
| | - Chen Guo
- The First Medical Clinical College of Lanzhou University, Lanzhou, China
| | - Min Li
- The First Medical Clinical College of Lanzhou University, Lanzhou, China
| | - Yong-Hui Lv
- The First Medical Clinical College of Lanzhou University, Lanzhou, China
| | - Yu-Dong Fan
- Department of Cardiology, Emergency General Hospital, Beijing, China
| | - Zhi-Lu Wang
- The First Medical Clinical College of Lanzhou University, Lanzhou, China
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, China
- * E-mail:
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42
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Álvarez Álvarez B, Abou Jokh Casas C, Cordero A, Martínez Gómez Á, Cid Álvarez AB, Agra Bermejo R, García Acuña JM, Gude Sampedro F, González Juanatey JR. Early revascularization and long-term mortality in high-risk patients with non-ST-elevation myocardial infarction. The CARDIOCHUS-HUSJ registry. ACTA ACUST UNITED AC 2019; 73:35-42. [PMID: 31122784 DOI: 10.1016/j.rec.2019.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/27/2019] [Indexed: 11/17/2022]
Abstract
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 darly 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 24hours after hospital admission) may be associated with reduced all-cause mortality and cardiovascular mortality at long-term follow-up.
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Affiliation(s)
- Belén Álvarez Álvarez
- Departamento de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV).
| | - Charigan Abou Jokh Casas
- Departamento de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV).
| | - Alberto Cordero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV); Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Álvaro Martínez Gómez
- Departamento de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)
| | - Ana Belén Cid Álvarez
- Departamento de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)
| | - Rosa Agra Bermejo
- Departamento de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)
| | - José María García Acuña
- Departamento de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)
| | - Francisco Gude Sampedro
- Departamento de Epidemiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - José Ramón González Juanatey
- Departamento de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)
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43
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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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Hoedemaker NPG, Damman P, Bosker HA, Danse PW, Liem AH, Geerdes B, van Laarhoven H, de Winter RJ. Treatment patterns of non-ST-elevation acute coronary syndrome patients presenting at non-PCI centres in the Netherlands and possible logistical consequences of adopting same-day transfer to PCI centres: a registry-based evaluation. Neth Heart J 2019; 27:191-199. [PMID: 30684141 PMCID: PMC6439038 DOI: 10.1007/s12471-019-1229-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND European Society of Cardiology (ESC) guidelines recommend same-day transfer to a percutaneous coronary intervention (PCI) centre for angiography in high-risk (ESC-HR) patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). We describe the treatment patterns of NSTE-ACS patients presenting at non-PCI centres and evaluate the logistical consequences of adopting same-day transfer. METHODS From August 2016 until January 2017, all consecutive NSTE-ACS patients presenting at 23 non-PCI centres in the Netherlands were recorded. We built an online case report form in collaboration with the National Cardiovascular Database Registry to collect information on risk stratification by the attending physician, timing and location of angiography, and treatment. RESULTS We included 871 patients (mean age 69.1 ± 12.8). 55.8% were considered ESC-HR. Overall, angiography at non-PCI centres was 55.1% and revascularisation was 54.1%. Among ESC-HR patients, angiography at non-PCI centres was 51.4% and revascularisation was 54.9%. Angiography <24 h was 55.6% in patients with angiography at a non-PCI centre and 74.3% in patients with angiography at a PCI-centre. Assuming patients would receive similar treatment, adoption of same-day transfer would increase transfers of ESC-HR patients who undergo PCI (44.3%), but also increases transfers of medically treated patients (36.2%) and patients awaiting coronary bypass artery grafting (9.1%). CONCLUSIONS In this registry of NSTE-ACS patients at non-PCI centres, the majority of ESC-HR patients underwent angiography at a non-PCI centre. Same-day transfer occurred in one-quarter of the ESC-HR patients, despite guideline recommendation. Nonselective adoption of same-day transfer to a PCI centre would increase transfers of ESC-HR patients who undergo PCI, however, equally increases transfers of patients who are medically treated.
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Affiliation(s)
- N P G Hoedemaker
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - P Damman
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - H A Bosker
- Department of Cardiology, Rijnstate Ziekenhuis, Arnhem, The Netherlands
| | - P W Danse
- Department of Cardiology, Rijnstate Ziekenhuis, Arnhem, The Netherlands
| | - A H Liem
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - B Geerdes
- Achmea Health Insurance Company, Zeist, The Netherlands
| | - H van Laarhoven
- De Hart&Vaatgroep/Dutch Heart Foundation, The Hague, The Netherlands
| | - R J de Winter
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Malik AH, Siddiqui N, Aronow WS. Unstable angina: trends and characteristics associated with length of hospitalization in the face of diminishing frequency-an evidence of a paradigm shift. ANNALS OF TRANSLATIONAL MEDICINE 2019; 6:454. [PMID: 30603642 DOI: 10.21037/atm.2018.11.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Unstable angina (UA) has been one of the most common presentations of acute coronary syndrome. The numbers of admitted UA patients have been diminishing in the recent past. However, we are seeing higher costs and higher length of inpatient stay. We attempt to identify the trends and characteristics of length of hospitalization in patients admitted with UA using a nationally representative dataset. Methods We used the nationwide inpatient sample (NIS) from 2002-2014 to assess the factors associated with length of stay in patients admitted with unstable angina using ICD-9-CM primary diagnosis codes (411.1, 411.81, and 411.89). All variables pertaining to hospitalization were compared across the 3 groups based on varied length of hospital stay. Results A total of 131,601 patients were admitted with the diagnosis of UA. The length of inpatient stay was ≤1 day, 2-6 days, and ≥7 days in 60,309 (45.83%), 67,291 (51.13%), and 4,001 (3.05%) patients, respectively. In a multivariate adjusted model, the percentage increased odds of ≥2 days of inpatient stay was noted as follows: age ≥65 years (29%), female gender(24%), African-American race (28%), obesity (14%), diabetes mellitus (15%), chronic lung disease (33%), congestive heart failure (529%), renal failure (26%), coagulopathy (68%), alcohol abuse (21%), peripheral vascular disease (22%), myocardial infarction (17%), deep vein thrombosis (119%), sepsis (105%), pneumonia (171%), stroke (164%), urinary tract infection (112%), blood loss (95%), cardiac catheterization (86%), percutaneous transluminal coronary angioplasty (24%), and blood transfusion (206%). The percentage of UA patients with ≥2 days of hospital stay has decreased from 15% to 3.7%, whereas the average costs of managing a UA patient in the hospital have increased by 175%. Conclusions More than half of patients admitted with UA stay in the hospital for ≥2 days, with the most important determinants being pre-existing medical comorbidities and inpatient complications.
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Affiliation(s)
- Aaqib H Malik
- Department of Medicine, Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Nauman Siddiqui
- Department of Hematology and Oncology, Tufts Medical Center, Boston, MA, USA
| | - Wilbert S Aronow
- Department of Medicine, Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
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Badings EA, Hermanides RS, Van Der Sluis A, Dambrink JHE, Gosselink ATM, Kedhi E, Ottervanger JP, Roolvink V, Remkes WS, Van't Riet E, Suryapranata H, Van't Hof AWJ. Use, timing and outcome of coronary angiography in patients with high-risk non-ST-segment elevation acute coronary syndrome in daily clinical practice: insights from a 'real world' prospective registry. Neth Heart J 2018; 27:73-80. [PMID: 30547413 PMCID: PMC6352622 DOI: 10.1007/s12471-018-1212-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background An early invasive strategy (EIS) is recommended in high-risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), defined as coronary angiography (CAG), within 24 h of admission. The aim of the present study is to investigate guideline adherence, patient characteristics associated with timing of the intervention and clinical outcome. Methods In a prospective registry, the use and timing of CAG and the characteristics and clinical outcome associated with timing were evaluated in high-risk ACS patients. The outcome of early versus delayed invasive strategy (DIS) was compared. Results Between 2006 and 2014, 2,299 high-risk NSTE-ACS patients were included. The use of CAG increased from 77% in 2006 to 90% in 2014 (p trend <0.001) together with a decrease of median time to CAG from 23.3 to 14.5 h (p trend <0.001) and an increase of patients undergoing EIS from 50 to 60% (p trend = 0.002). Patient factors independently related to DIS were higher GRACE risk score, higher age and the presence of comorbidities. No difference was found in incidence of mortality, reinfarction or bleeding at 30-day follow-up. All-cause mortality at 1‑year follow-up was 4.1% vs 7.0% in EIS and DIS respectively (hazard ratio 1.67, 95% confidence interval 1.12–2.49) but was comparable after adjustment for confounding factors. Conclusion The percentage of high-risk NSTE-ACS patients undergoing CAG and EIS has increased in the last decade. In contrast to the guidelines, patients with a higher risk profile are less likely to undergo EIS. However, no difference in outcome after 30 days and 1 year was found after multivariate adjustment for this higher risk.
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Affiliation(s)
- E A Badings
- Department of Cardiology, Deventer Hospital, Deventer, The Netherlands.
| | | | - A Van Der Sluis
- Department of Cardiology, Deventer Hospital, Deventer, The Netherlands
| | | | | | - E Kedhi
- Isala Heart Centre, Zwolle, The Netherlands
| | | | - V Roolvink
- Isala Heart Centre, Zwolle, The Netherlands
| | - W S Remkes
- Isala Heart Centre, Zwolle, The Netherlands
| | - E Van't Riet
- Teaching Hospital, Deventer Hospital, Deventer, The Netherlands
| | - H Suryapranata
- Isala Heart Centre, Zwolle, The Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A W J Van't Hof
- Isala Heart Centre, Zwolle, The Netherlands
- Department of Cardiology, Maastricht UMC+, Maastricht, The Netherlands
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47
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Jneid H. Invasive Strategy After Non-ST-Segment Elevation Acute Coronary Syndrome: Timing and Controversies. JACC Cardiovasc Interv 2018; 9:2277-2279. [PMID: 27884353 DOI: 10.1016/j.jcin.2016.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Hani Jneid
- Division of Cardiology, Baylor College of Medicine; and the Michael E. DeBakey VA Medical Center, Houston, Texas.
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48
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Navarese EP, Wernly B, Lichtenauer M, Pepe M, Wanha W, Ferrante G, Frediani L, Veulemans V, Zeus T, Westenfeld R, Jung C, Gurbel PA. Prime time for the sweet spot in timing of coronary invasive approach in patients with non-ST elevation myocardial infarction. J Thorac Dis 2018; 10:17-20. [PMID: 29600012 DOI: 10.21037/jtd.2017.11.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Eliano P Navarese
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Fairfax, VA, USA.,SIRIO MEDICINE Cardiovascular research network, VA, USA
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Martino Pepe
- Department of Emergency and Organ Transplant, Cardiology Unit, Bari University Hospital, Bari, Italy
| | - Wojciech Wanha
- Division of Cardiology and Structural Heart DiseasesMedical University of Silesia, Katowice, Poland
| | - Giuseppe Ferrante
- Department of Cardiovascular Medicine, Humanitas Research Hospital, Rozzano, Italy
| | - Lara Frediani
- Department of Cardiology, Livorno Hospital, Azienda Usl Toscana Nord-Ovest, Ospedali Riuniti di Livorno, Livorno, Italy
| | - Verena Veulemans
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Tobias Zeus
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Paul A Gurbel
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Fairfax, VA, USA.,SIRIO MEDICINE Cardiovascular research network, VA, USA
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49
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Percutaneous coronary interventions for non-ST elevation acute coronary syndromes - The two faces of inappropriateness. Int J Cardiol 2018; 255:20-21. [PMID: 29425559 DOI: 10.1016/j.ijcard.2018.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 01/04/2018] [Indexed: 11/22/2022]
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50
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Schmidt FP, Schmitt C, Hochadel M, Giannitsis E, Darius H, Maier LS, Schmitt C, Heusch G, Voigtländer T, Mudra H, Gori T, Senges J, Münzel T. Invasive treatment of NSTEMI patients in German Chest Pain Units – Evidence for a treatment paradox. Int J Cardiol 2018; 255:15-19. [DOI: 10.1016/j.ijcard.2017.11.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 10/31/2017] [Accepted: 11/03/2017] [Indexed: 12/11/2022]
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