1
|
Herrero-Brocal M, Marín F, Valverde L, García-Barrios AM, Fuertes L, Cambra C, Torres-Mezcua F, Hortelano I, Villamia B, Esteve-Pastor MA, Orenes-Piñero E, Martínez JGM, Rivera-Caravaca JM, Ruiz-Nodar JM. High medium-term incidence of major cardiovascular events in discharged patients with unstable angina. IJC HEART & VASCULATURE 2023; 46:101209. [PMID: 37152426 PMCID: PMC10160493 DOI: 10.1016/j.ijcha.2023.101209] [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: 02/22/2023] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 05/09/2023]
Abstract
The introduction of high-sensitivity troponin (hsTn) assays has reduced the diagnosis of unstable angina (UA) in favor of non-ST elevation myocardial infarction (NSTEMI) in the context of non-ST elevation acute coronary syndrome (NSTEACS). It is unclear whether the detection of these hsTn levels affects the prognosis and therefore whether a different therapeutic approach is warranted. This study aims to determine whether using hsTn results in medium-term prognostic differences in patients with UA and NSTEMI. Methods This multicenter, prospective registry study included consecutive patients who underwent hsTn assays and were discharged with a diagnosis of NSTEACS. Patients were followed for two years. Outcomes were the occurrence of major adverse cardiovascular events (MACE: cardiovascular death, non-fatal myocardial infarction, and non-fatal ischemic stroke), major bleeding, and all-cause mortality. Results Patients with UA and NSTEMI did not show differences in terms of the invasive interventions received, the coronary artery disease diagnosed, the type of revascularization performed, or the proportion presenting MACE (UA 18.1% vs. NSTEMI 18.9%; p = 0.79). However, patients with NSTEMI had higher cardiovascular mortality at two years (UA 4% vs. NSTEMI 9.2%; p = 0.012), as well as, all-cause mortality (UA vs. 7.9% vs. NSTEMI 16.4%; p = 0.002). Conclusions Medium-term incidence of MACE was similar in patients with UA and NSTEMI, but cardiovascular and all-cause mortality in NSTEMI patients was over twice that of patients with UA.
Collapse
Affiliation(s)
- Marta Herrero-Brocal
- Cardiology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Laura Valverde
- Cardiology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Ana M. García-Barrios
- Cardiology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Laura Fuertes
- Cardiology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Cristina Cambra
- Cardiology Department, Torrevieja University Hospital, Alicante, Spain
| | - Fernando Torres-Mezcua
- Cardiology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Ignacio Hortelano
- Cardiology Department, Hospital Marina Baja de Villajoyosa, Alicante, Spain
| | - Beatriz Villamia
- Cardiology Department, Torrevieja University Hospital, Alicante, Spain
| | - María Asunción Esteve-Pastor
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Esteban Orenes-Piñero
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Juan Gabriel Martínez Martínez
- Cardiology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - José Miguel Rivera-Caravaca
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Juan M. Ruiz-Nodar
- Cardiology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Corresponding author at: Department of Cardiology, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), C/Maestro Alonso s/n, 03010 Alicante, Spain.
| |
Collapse
|
2
|
Bularga A, Meah MN, Doudesis D, Shah ASV, Mills NL, Newby DE, Lee KK. Duration of dual antiplatelet therapy and stability of coronary heart disease: a 60 000-patient meta-analysis of randomised controlled trials. Open Heart 2021; 8:e001707. [PMID: 34341097 PMCID: PMC8330558 DOI: 10.1136/openhrt-2021-001707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/13/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Dual antiplatelet therapy (DAPT) has important implications for clinical outcomes in coronary disease. However, the optimal DAPT duration remains uncertain. METHODS AND RESULTS We searched four major databases for randomised controlled trials comparing long-term (≥12 months) with short-term (≤6 months) or shorter (≤3 months) DAPT in patients with coronary syndromes. The primary outcome was all-cause mortality. Secondary outcomes were any bleeding and major bleeding (safety), cardiac death, myocardial infarction, stent thrombosis, revascularisation and stroke (efficacy). Nineteen randomised controlled trials (n=60 111) satisfied inclusion criteria, 8 assessed ≤3 months DAPT. Compared with long-term (≥12 months), short-term DAPT (≤6 months) was associated with a trend towards reduced all-cause mortality (RR: 0.90, 95% CI: 0.80 to 1.01) and significant bleeding reduction (RR: 0.68, 95% CI: 0.55 to 0.83 and RR: 0.66, 95% CI: 0.56 to 0.77 for major and any bleeding, respectively). There were no significant differences in efficacy outcomes. These associations persisted in sensitivity analysis comparing shorter duration DAPT (≤3 months) to long-term DAPT (≥12 months) for all-cause mortality (RR: 0.91, 95% CI: 0.79 to 1.05). In subgroup analysis, short-term DAPT was associated with lower risk of bleeding in patients with acute or chronic coronary syndromes (RR: 0.66, 95% CI: 0.54 to 0.81 and RR: 0.53, 95% CI: 0.33 to 0.65, respectively), but higher risk of stent thrombosis in acute coronary syndrome (RR: 1.49, 95% CI: 1.02 to 2.17 vs RR: 1.25, 95% CI 0.44 to 3.58). CONCLUSION Our meta-analysis suggests that short (≤6 months) and shorter (≤3 months) durations DAPT are associated with lower risk of bleeding, equivalent efficacy and a trend towards lower all-cause mortality irrespective of coronary artery disease stability.
Collapse
Affiliation(s)
- Anda Bularga
- BHF Centre for Cardiovascular Science, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
| | - Mohammed N Meah
- BHF Centre for Cardiovascular Science, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
| | - Dimitrios Doudesis
- BHF Centre for Cardiovascular Science, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
| | - Anoop S V Shah
- Department of Non-Communicable Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
- Usher Institute, University of Edinburgh Division of Health Sciences, Edinburgh, UK
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
| | - Kuan Ken Lee
- BHF Centre for Cardiovascular Science, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
| |
Collapse
|
3
|
Santos RCO, Bensenor IM, Goulart AC, Lotufo PA, Santos IS. Frequency and Reasons for Non-Administration and Suspension of Drugs During an Acute Coronary Syndrome Event. The ERICO Study. Arq Bras Cardiol 2020; 115:830-839. [PMID: 33295445 PMCID: PMC8452196 DOI: 10.36660/abc.20190317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/26/2019] [Accepted: 10/23/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Few studies have discussed the reasons for pharmacological undertreatment of Acute Coronary Syndrome (ACS). OBJECTIVES To determine the frequency and reasons for the non-administration and suspension of medications during in-hospital treatments of ACS in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study. METHODS The present study analyzed the medical charts of the 563 participants in the ERICO study to evaluate the frequency and reasons for the non-administration and/or suspension of medications. Logistic regression models were built to analyze if sex, age ≥65 years of age, educational level, or ACS subtype were associated with (a) the non-administration of ≥1 medications; and (b) the non-administration or suspension of ≥1 medications. The significance level was set at 5%. RESULTS This study's sample included 58.1% males, with a median of 62 years of age. In 183 (32.5%) participants, ≥1 medications were not administered, while in 288 (51.2%), ≥1 medications were not administered or were suspended. The most common reasons were the risk of bleeding (aspirin, clopidogrel, and heparin), heart failure (beta blockers), and hypotension (angiotensin-converting enzyme inhibitors and angiotensin receptor blockers). Individuals aged ≥65 (odds ratio [OR]:1.51; 95% confidence interval [95% CI]:1.05-2.19) and those with unstable angina (OR:1.72; 95% CI:1.07-2.75) showed a higher probability for the non-administration of ≥1 medication. Considering only patients with myocardial infarction, being ≥65 years of age was associated with both the non-administration and the non-administration or suspension of ≥1 medication. CONCLUSIONS Non-administration or suspension of ≥1 medication proved to be common in this ERICO study. Individuals of ≥65 years of age or with unstable angina showed a higher probability of the non-administration of ≥1 medication and may be undertreated in this scenario. (Arq Bras Cardiol. 2020; 115(5):830-839).
Collapse
Affiliation(s)
- Rafael C. O. Santos
- Universidade de São PauloHospital Universitário da USPCentro de Pesquisa Clínica e EpidemiológicaSão PauloSPBrasilUniversidade de São Paulo - Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da USP, São Paulo, SP - Brasil
| | - Isabela M. Bensenor
- Universidade de São PauloHospital Universitário da USPCentro de Pesquisa Clínica e EpidemiológicaSão PauloSPBrasilUniversidade de São Paulo - Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da USP, São Paulo, SP - Brasil
- Universidade de São PauloFaculdade de Medicina da USPDepartamento de Clínica MédicaSão PauloSPBrasilUniversidade de São Paulo - Departamento de Clínica Médica da Faculdade de Medicina da USP, São Paulo, SP - Brasil
| | - Alessandra C. Goulart
- Universidade de São PauloHospital Universitário da USPCentro de Pesquisa Clínica e EpidemiológicaSão PauloSPBrasilUniversidade de São Paulo - Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da USP, São Paulo, SP - Brasil
| | - Paulo A. Lotufo
- Universidade de São PauloHospital Universitário da USPCentro de Pesquisa Clínica e EpidemiológicaSão PauloSPBrasilUniversidade de São Paulo - Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da USP, São Paulo, SP - Brasil
- Universidade de São PauloFaculdade de Medicina da USPDepartamento de Clínica MédicaSão PauloSPBrasilUniversidade de São Paulo - Departamento de Clínica Médica da Faculdade de Medicina da USP, São Paulo, SP - Brasil
| | - Itamar S. Santos
- Universidade de São PauloHospital Universitário da USPCentro de Pesquisa Clínica e EpidemiológicaSão PauloSPBrasilUniversidade de São Paulo - Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da USP, São Paulo, SP - Brasil
- Universidade de São PauloFaculdade de Medicina da USPDepartamento de Clínica MédicaSão PauloSPBrasilUniversidade de São Paulo - Departamento de Clínica Médica da Faculdade de Medicina da USP, São Paulo, SP - Brasil
| |
Collapse
|