Comparison of Noninvasively and Invasively Managed Patients, With or Without Revascularization in Non–ST Elevation Myocardial Infarction (from the Acute Coronary Syndrome Israeli Survey)

      Patients with non–ST elevation myocardial infarction who are managed noninvasively at presentation or are catheterized but without revascularization represent a heterogeneous and understudied population. We evaluated the clinical characteristics, management strategies, and outcomes of patients with non–ST elevation myocardial infarction (NSTEMI) who were enrolled in the prospective biannual Acute Coronary Syndrome Israeli Surveys from 2004 to 2013. Patients were divided into 3 groups: no catheterization (no angio), catheterization with revascularization (angio-revascularized), and catheterization without revascularization (angio-nonrevascularized) groups. The study included 3,198 patients with NSTEMI. Coronary angiography was performed in 2,525 (79%) during the index hospitalization, of whom 1899 (59%) underwent revascularization. Evidence-based therapies were administered during the index hospitalization at a significantly higher rate to those in the angio-revascularized group compared with the other 2 groups. Multivariate analysis showed that compared with those in the angio-revascularized and angio-nonrevascularized groups, patients in the no angio group experienced a significantly higher risk for 1-year mortality (hazard ratio 2.04 [p ≤0.0001] and 1.21 [p = 0.01], respectively). The risk associated with no revascularized was consistent in each risk subset analyzed, including an older age, and increased creatinine levels. In conclusion, our data, from a large real-world contemporary experience, suggest that patients with NSTEMI who do not undergo coronary revascularization during the index hospitalization represent a greater risk and undertreated group with increased risk for long-term mortality.
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        • Roffi M.
        • Patrono C.
        • Collet J.P.
        • Mueller C.
        • Valgimigli M.
        • Andreotti F.
        • Bax J.J.
        • Borger M.A.
        • Brotons C.
        • Chew D.P.
        • Gencer B.
        • Hasenfuss G.
        • Kjeldsen K.
        • Lancellotti P.
        • Landmesser U.
        • Mehilli J.
        • Mukherjee D.
        • Storey R.F.
        • Windecker S.
        • Baumgartner H.
        • Gaemperli O.
        • Achenbach S.
        • Agewall S.
        • Badimon L.
        • Baigent C.
        • Bueno H.
        • Bugiardini R.
        • Carerj C.
        • Casselman F.
        • Cuisset T.
        • Erol Ç.
        • Fitzsimons D.
        • Halle M.
        • Hamm C.
        • Hildick-Smith D.
        • Huber K.
        • Iliodromitis E.
        • James S.
        • Lewis B.L.
        • Lip G.Y.H.
        • Piepoli M.E.
        • Richter D.
        • Rosemann T.
        • Sechtem U.
        • Steg G.
        • Vrints C.
        • Zamorano J.L.
        ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.
        Eur Heart J. 2015; 37: 267-315
        • Chan M.Y.
        • Becker R.C.
        • Harrington R.A.
        • Peterson E.D.
        • Armstrong P.W.
        • White H.
        • Fox K.A.
        • Ohman E.M.
        • Roe M.T.
        Noninvasive, medical management for non-ST-elevation acute coronary syndromes.
        Am Heart J. 2008; 155: 397-407
        • Roe M.T.
        • White J.A.
        • Kaul P.
        • Tricoci P.
        • Lokhnygina Y.
        • Miller C.D.
        • van't Hof A.W.
        • Montalescot G.
        • James S.K.
        • Saucedo J.
        • Ohman E.M.
        • Pollack C.V.
        • Hochman J.S.
        • Armstrong P.W.
        • Giugliano R.P.
        • Harrington R.A.
        • Van de Werf F.
        • Califf R.M.
        • Newby L.K.
        Regional patterns of use of medical management strategy for patients with non-ST-elevation acute coronary syndromes: insights from the EARLY ACS trial.
        Circ Cardiovasc Qual Outcomes. 2012; 5: 205-213
        • Lindholm D.
        • Varenhorst C.h.
        • Cannon C.P.
        • Harrington R.A.
        • Himmelmann A.
        • Maya J.
        • Husted S.
        • Steg P.G.
        • Cornell J.H.
        • Storey R.F.
        • Stevens S.R.
        • Wallentin L.
        • James S.
        Ticagrelor versus clopidogrel in patients with non-ST-elevation acute coronary syndrome with or without revascularization: results from the PLATO trial.
        Eur Heart J. 2014; 35: 2083-2093
        • Solomon M.D.
        • Go A.S.
        • Shilane D.
        • Boothroyd D.B.
        • Leong T.K.
        • Kazi D.S.
        • Chang T.I.
        • Hlatky M.A.
        Comparative effectiveness of clopidogrel in medically managed patients with unstable angina and non-ST-segment elevation myocardial infarction.
        J Am Coll Cardiol. 2014; 63: 2249-2257
        • Amsterdam E.A.
        • Peterson E.D.
        • Ou F.S.
        • Newby L.K.
        • Pollack Jr., C.V.
        • Gibler W.B.
        • Ohman E.M.
        • Roe M.T.
        Comparative trends in guidelines adherence among patients with non-ST-segment elevation acute coronary syndromes treated with invasive versus conservative management strategies: results from the CRUSADE quality improvement initiative.
        Am Heart J. 2009; 158: 748-754
        • Ohman E.M.
        • Harskamp R.E.
        We need to do better for patients with non-ST-segment elevation acute coronary syndrome who are managed without revascularization.
        J Am Coll Cardiol. 2014; 63: 2258-2260
        • Lubovich A.
        • Hamood H.
        • Behar S.
        • Rosenschein U.
        Bypassing the emergency room to reduce door-to-balloon time and improve outcomes of patients with ST elevation myocardial infarction: the Acute Coronary Syndrome Israeli Survey experience.
        Isr Med Assoc J. 2011; 13: 216-219
        • Roe M.T.
        • Armstrong P.W.
        • Fox K.A.A.
        • White H.D.
        • Prabhakaran D.
        • Goodman S.G.
        • Cornel J.H.
        • Bhatt D.L.
        • Clemmensen P.
        • Martinez F.
        • Ardissino D.
        • Nicolau J.C.
        • Boden W.E.
        • Gurbel P.A.
        • Ruzyllo W.
        • Dalby A.J.
        • McGuire D.K.
        • Leiva-Pons J.L.
        • Parkhomenko A.
        • Gottlieb S.
        • Topacio G.O.
        • Hamm C.h.
        • Pavlides G.
        • Goudev A.R.
        • Oto A.
        • Tseng C.D.
        • Merkely B.
        • Gasparovic V.
        • Corbalan R.
        • Cinteză M.
        • McLendon C.
        • Winters K.J.
        • Brown E.B.
        • Lokhnygina Y.
        • Aylward P.E.
        • Huber K.
        • Hochman J.S.
        • Ohman E.M.
        • for the TRILOGY ACS Investigator
        Prasugrel versus clopidogrel for acute coronary syndromes without revascularization.
        N Engl J Med. 2012; 367: 1297-1309
        • James S.K.
        • Roe M.T.
        • Cannon C.P.
        • Cornel J.H.
        • Horrow J.
        • Husted S.
        • Katus H.
        • Morais J.
        • Steg P.G.
        • Storey R.F.
        • Stevens S.
        • Wallentin L.
        • Harrington R.A.
        Ticagrelor versus clopidogrel in patients with acute coronary syndrome intended for non-invasive management: substudy from prospective randomized Platelet Inhibition and Patient Outcomes (PLATO) trial.
        BMJ. 2011; 342: 3527-3538