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Is the early invasive strategy really the optimal time for patients at high-risk of acute coronary syndromes without ST-segment elevation
Session:
Painel 7 -Doença Coronária 5
Speaker:
Isabel Campos
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Isabel Durães Campos; Cátia Costa Oliveira; Carla Marques Pires; Paulo Medeiros; Rui Files Flores; Fernando Ribeiro Mané; Carlos Galvão Braga; António Coelho Gaspar; em nome dos investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p>An early invasive strategy (<24h) has become the standard of care for patients (pts) at high-risk of acute coronary syndromes without ST-segment elevation (NSTE-ACS) in the latest guidelines. However, the optimal timing of coronary intervention in pts with NSTE-ACSs is still a matter of debate.</p> <p><strong>Aim: </strong>To compare the prognosis between pts at high-risk of NSTE-ACS submitted an early (<24h) versus a delayed invasive strategy (24-72h) in Portugal.</p> <p><strong>Methods: </strong>A retrospective multicenter observational study including 6722 pts at high-risk NSTE-ACS (established diagnosis of NSTE-ACS based on cardiac troponins OR dynamic ST/T-changes OR GRACE score>140). Low, intermediate and very high-risk of NSTE-ACS pts were excluded, such as pts with an invasive strategy >72h. Pts were divided into two groups: group 1 – pts at high-risk of NSTE-ACS submitted an early invasive strategy (<24h) (n=3351, 49.9%); group 2 - pts at high-risk of NSTE-ACS submitted a delayed invasive strategy (24-72h) (n=3371, 50.1%). Primary endpoint was the occurrence of death at 1 year; follow-up was completed in 50% of patients. </p> <p><strong>Results: </strong>The sample was formed by 5010 (74.5%) men and 1712 (25.5%) women, with mean age of 65 ± 12 years. It was not observed statistically significant differences in gender (75.2 vs 73.9, p=0.230) and age (64±12 vs 65±12, p=0.008). Group 2 pts had a higher prevalence of hypertension (69.4% vs 73.0%, p=0.001), dyslipidaemia (63.1% vs 66.7%, p=0.002), peripheral arterial disease (4.2% vs 5.8%, p=0.003), chronic kidney disease (3.2% vs 4.9%, p<0.001), and history of previous myocardial infarction (19.9% vs 24.3%, p<0.001), CABG (4.7% vs 6.0%, p=0.017) and heart failure (2.4% vs 3.4%, p=0.012). They also were taking more often vitamin K antagonist (1.6% vs 2.6%, p=0.004). On admission, group 1 pts had more chest pain (96.9% vs 95.7%, p=0.010) compared to group 2 pts that had more dyspnea (1.1% vs 1.9%, p=0.007) and presented more to a non-PCI center (36.0% vs 46.3%, p<0.001). During hospitalization, group 2 had more often ST transition changes (5.3% vs 3.9%, p=0.006), heart failure (3.3% vs 4.5%, p=0.013) and LVEF ≤ 40% (5.9% vs 7.6%, p=0.042). Group 1 pts were more likely to have coronary revascularization (78.9% vs 74.6%, p<0.001), with the culprit artery being less identified in group 2 (20.8% vs 25.2%, p <0.001). Group 1 and 2 had the same 1-year mortality (3.0% vs 2.8%; p=0.755). In multivariate analysis and after adjusting for different baseline characteristics, pts at high-risk of NSTE-ACS submitted an early strategy (<24h) had the same risk of 1-year mortality compared to those submitted a delayed invasive strategy (48-72h) [OR 0.76, p=0.280].</p> <p><strong>Conclusions: </strong>In Portugal, only half of patients at high risk of NSTE-ACS undergo an early invasive strategy (<24h). However the early invasive coronary evaluation did not improve overall long-term clinical outcome compared with delayed invasive strategy (24-72h) in this group of pts.</p>
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