Comprehensive evaluation of time-varied outcomes for invasive and conservative strategies in patients with NSTE-ACS: a meta-analysis of randomized controlled trials

Diagnostic Value and Short-Term Prognosis Assessment of Copeptin in Non-ST-Elevation Acute Coronary Syndrome

This study explored the early diagnosis and prognostic value of copeptin in non-ST-segment elevation acute coronary syndrome (NSTE-ACS). 171 patients with chest pain or myocardial ischemia symptoms were enrolled. Patients with NSTE-ACS were further divided into the non-ST-elevation myocardial infarction (NSTEMI) and unstable angina (UA). All NSTE-ACS patients were followed up to record the occurrence of Major Adverse Cardiovascular Events (MACEs). Serum copeptin concentration in the NSTE-ACS group was significantly higher than that in the control group. The Area under the curve (AUC) value of copeptin in the diagnosis of NSTE-ACS was 0.798. The combined AUC value of copeptin and hypersensitive troponin I (hs-TnI) to NSTE-ACS increased to 0.930. In addition, copeptin and hs-TnI have been proven to be independent risk factors for MACEs in patients with NSTE-ACS. The use of copeptin in combination with conventional myocardial markers contributes to the early diagnosis and short-term prognosis assessment of NSTE-ACS.

Impact of access to coronary angiography and percutaneous coronary intervention on in-hospital and five-year mortality in patients with acute coronary syndrome: a propensity-matched cohort study in Thailand

BACKGROUND

Coronary artery angiography (CAG) and percutaneous coronary intervention (PCI) are superior to non-invasive approaches in reducing mortality in patients with ST-segment elevation myocardial infarction (STEMI). However, their efficacy remains uncertain in non-ST-elevation acute coronary syndromes (NSTE-ACS) and limited in low-resource settings. This study aimed to compare in-hospital and 5-year mortality rates between patients with a first event of STEMI and NSTE-ACS who underwent CAG and PCI and those with similar severity who did not undergo CAG and PCI.

METHODS

A propensity-matched retrospective cohort study was conducted using population-based claims data of national universal coverage of Thailand for identification of patients with acute coronary syndromes. The mortality of recruited patients was additionally linked to the national database of vital registration. Patients aged ≥ 40 years who were hospitalized for STEMI and NSTE-ACS in 2017, with a focus on access to CAG and PCI were included. For each condition either STEMI or NSTE-ACS, patients who underwent CAG and PCI were matched to those who did not undergo using propensity score matching (PSM) to balance measured confounders, such as age, sex, and underlying conditions. In-hospital mortality rate ratio and 5-year mortality were analyzed as measures.

RESULTS

Through PSM, 2,702 non-intervention STEMI patients were paired with an equal number of intervention patients, and similarly, 5,072 non-intervention NSTE-ACS patients were matched with an equivalent group who received interventions. For patients with STEMI, the in-hospital mortality rate ratio (95% confidence interval (CI)) for those who underwent CAG and PCI compared to those who did not was 30.1% (30.0%, 30.2%). Similar trends were observed in patients with NSTE-ACS with a mortality rate of 34.7% (34.6%, 34.8%). For the five-year mortality comparison, the hazard ratios (95% CI) of mortality after discharge were 0.55 (0.50, 0.62) for STEMI and 0.57 (0.54, 0.61) for NSTE-ACS cases.

CONCLUSIONS

Access to CAG and PCI was significantly associated with lower in-hospital and 5-year mortality rates in patients who experienced their first event of ACS, despite the limited availability of some unmeasured or residual confounders. Healthcare systems should expand their resources for CAG and PCI in Thailand and other countries to equitably enhance longevity.