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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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Silva PGMDBE, Berwanger O, Santos ESD, Sousa ACS, Cavalcante MA, Andrade PBD, Neuenschwander FC, Vargas Filho H, Guimarães JI, Andrade J, Paola AAVD, Malachias MVB, Mattos LAPE, Precoma DB, Bacal F, Dutra OP. One year follow-up Assessment of Patients Included in the Brazilian Registry of Acute Coronary Syndromes (ACCEPT). Arq Bras Cardiol 2020; 114:995-1003. [PMID: 32638905 PMCID: PMC8416119 DOI: 10.36660/abc.20190879] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/08/2020] [Indexed: 11/30/2022] Open
Abstract
Fundamento Existe carência de informações prospectivas sobre a evolução em um ano após uma síndrome coronária aguda (SCA) em uma grande amostra de pacientes brasileiros. Objetivos Avaliar a prescrição de terapias baseadas em evidência, a ocorrência de desfechos graves e os preditores para estes desfechos em um registro brasileiro multicêntrico de pacientes com SCA. Métodos O ACCEPT é um estudo observacional prospectivo que incluiu pacientes internados com diagnóstico de SCA em 47 hospitais brasileiros. Os pacientes foram seguidos por 1 ano e coletou-se dados sobre prescrição médica e ocorrência de eventos cardiovasculares maiores (mortalidade cardiovascular, reinfarto e acidente vascular encefálico - AVE). Valores de p < 0,05 foram considerados estatisticamente significantes. Resultados Um total de 5.047 pacientes foram incluídos neste registro, de agosto de 2010 até abril de 2014. Foi confirmado o diagnóstico de SCA em 4.782 pacientes (94,7%) e, dentre os 3 diagnósticos possíveis, o mais comum foi SCA com elevação do segmento ST (35,8%). A taxa de eventos cardiovasculares maiores foi de 13,6 % em 1 ano. A prescrição completa de terapias baseadas em evidência na admissão hospitalar foi de 62,1%. Idade, atendimento público, infarto agudo do miocárdio, AVE, insuficiência renal, diabetes e qualidade da terapia estiveram associados de forma independente à ocorrência de eventos cardiovasculares maiores. Conclusões No seguimento de 1 ano do registro ACCEPT, mais de 10% dos pacientes apresentaram eventos cardiovasculares maiores e esta taxa variou de acordo com a qualidade da terapia. Há necessidade da elaboração de estratégias para melhorar o uso de terapias baseadas em evidência no sentido de minimizar os eventos cardiovasculares na população brasileira. (Arq Bras Cardiol. 2020; 114(6):995-1003)
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Fernando Bacal
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Oscar Pereira Dutra
- Instituto de Cardiologia, Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brasil
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Zhang B, Shen DP, Zhou XC, Liu J, Huang RC, Wang YE, Chen AM, Zhu YR, Zhu H. Long-term prognosis of patients with acute non-ST-segment elevation myocardial infarction undergoing different treatment strategies. Chin Med J (Engl) 2015; 128:1026-31. [PMID: 25881594 PMCID: PMC4832940 DOI: 10.4103/0366-6999.155071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: In cardiology, it is controversial whether different therapy strategies influence prognosis after acute coronary syndrome. We examined and compared the long-term outcomes of invasive and conservative strategies in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and characterized the patients selected for an invasive approach. Methods: A total of 976 patients with acute NSTEMI were collected from December 2006 to October 2012 in the First Affiliated Hospital of Dalian Medical University Hospital. They are divided into conservative strategy (586 patients) and invasive strategy (390 patients) group. Unified follow-up questionnaire was performed by telephone contact (cut-off date was November, 2013). The long-term clinical events were analyzed and related to the different treatment strategies. Results: The median follow-up time was 29 months. Mortality was 28.7% (n = 168) in the conservative group and 2.1% (n = 8) in the invasive management at long-term clinical follow-up. The secondary endpoint (the composite endpoint) was 59.0% (n = 346) in the conservative group and 30.3% (n = 118) in the invasive management. Multivariate analysis showed that patients in the conservative group had higher all-cause mortality rates than those who had the invasive management (adjusted risk ratio [RR] = 7.795; 95% confidence interval [CI]: 3.796–16.006, P < 0.001), and the similar result was also seen in the secondary endpoint (adjusted RR = 2.102; 95% CI: 1.694–2.610, P < 0.001). In the subgroup analysis according to each Thrombolysis in Myocardial Infarction risk score (TRS), log-rank analysis showed lower mortality and secondary endpoint rates in the invasive group with the intermediate and high-risk patients (TRS 3–7). Conclusions: An invasive strategy could improve long-term outcomes for NSTEMI patients, especially for intermediate and high-risk ones (TRS 3–7).
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Affiliation(s)
| | | | | | | | | | | | | | | | - Hao Zhu
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
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Yeom H, Kang DR, Cho SK, Lee SW, Shin DH, Kim HC. Admission route and use of invasive procedures during hospitalization for acute myocardial infarction: analysis of 2007-2011 National Health Insurance database. Epidemiol Health 2015; 37:e2015022. [PMID: 25968116 PMCID: PMC4459111 DOI: 10.4178/epih/e2015022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 05/01/2015] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The goal of this study was to investigate trends in admission to the emergency department and the use of invasive or surgical procedures during hospitalization for acute myocardial infarction (AMI) in Korea. METHODS The National Health Insurance (NHI) claims database between 2007 and 2011 was used. We identified all admission claims that included codes from the tenth revision of the International Classification of Diseases beginning with I21 as the primary or secondary diagnosis. Information about the admission route, admission date, discharge date, and whether coronary artery angiography, angioplasty, or bypass surgery was performed was also obtained from the NHI database. RESULTS Of the 513,886 relevant admission claims over the five years encompassed by this study, 295,001 discrete episodes of admission for AMI were identified by analyzing the date and length of each admission and the interval between admissions. The number of AMI admissions gradually decreased from 66,883 in 2007 to 47,656 in 2011. The number and proportion of admissions through the emergency department also decreased from 38,118 (57.0%) in 2007 to 24,001 (50.4%) in 2011. However, during the same period, admissions in which invasive or surgical procedures were performed increased from 15,342 (22.9%) to 17,505 (36.7%). CONCLUSIONS The reported numbers of emergency department visits and admissions for AMI decreased from 2007 to 2011. However, only a small portion of the patients underwent invasive or surgical procedures during hospitalization, although the number of admissions involving invasive or surgical procedures has increased. These findings suggest that simply counting the number of admission claims cannot provide valid information on trends in AMI occurrence.
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Affiliation(s)
- Hyungseon Yeom
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Ryong Kang
- Research Affairs, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Kyung Cho
- Division of Environmental Health, Environmental Policy Research Group, Seoul, Korea
| | - Seung Won Lee
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea.,Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Ho Shin
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.,Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea
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