Journal ArticleDOI
Delay to angiography and outcomes following presentation with high-risk, non-ST-elevation acute coronary syndromes: results from the Global Registry of Acute Coronary Events
Neil Swanson,Gilles Montalescot,Kim A. Eagle,Shaun G. Goodman,Wei Huang,David Brieger,Gerard Devlin +6 more
TLDR
Very long delay in patients presenting with high-risk non-ST-elevation acute coronary syndromes (NSTE-ACS) is suboptimally managed with 43% not undergoing angiography, compared to conservative management.Abstract:
Objective: To test if delay-to-angiography (>72 hours from admission) in patients presenting with high-risk non-ST-elevation acute coronary syndromes (NSTE-ACS) is associated with adverse outcomes. Design: GRACE (Global Registry of Acute Coronary Events) is a multinational registry of patients admitted with NSTE-ACS. Setting: 14 countries with varying healthcare systems. Patients: 23 396 high-risk NSTE-ACS patients with complete initial data collection entered into GRACE between 1999 and 2006 were analysed. Interventions: Data were analysed according to delay-to-angiography and subsequent in-hospital or post-discharge adverse outcomes. Main outcome measures: Outcomes recorded included death, myocardial infarction, recurrent ischaemia, stroke, new heart failure and composite major adverse cardiovascular event (MACE) comprising death, cerebrovascular accident and myocardial infarction. Revascularisation procedures were recorded. Results: 10 089 (43.1%) had no in-hospital angiography. Median delay-to-angiography was 46 hours; 3680 (34%) patients waited >72 hours. 9.3% waited >7 days before angiography. Patients waiting longest were more often older, diabetic, women and had a history of heart failure, previous myocardial infarction or hypertension. Recurrent in-hospital ischaemia (33% vs 22%), reinfarction (8.4% vs 5.0%) and heart failure (14% vs 9.1%) were more common with delayed angiography. Delayed angiography was associated with better outcomes than no angiography (MACE 18.9% vs 22.2%, p = 0.015). MACE rates within six months of admission were higher with longer delay-to-angiography and highest of all with no angiography. Conclusions: High-risk NSTE-ACS is suboptimally managed with 43% not undergoing angiography. One-third of those undergoing angiography are delayed >72 hours. Longer delays were more likely with higher risk, sicker patients. These delays were associated with adverse outcomes at six months. Very long delay was associated with lower MACE, but not mortality, compared to conservative management.read more
Citations
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Journal ArticleDOI
Early versus Delayed Invasive Intervention in Acute Coronary Syndromes
Shamir R. Mehta,Christopher B. Granger,William E. Boden,Philippe Gabriel Steg,Jean-Pierre Bassand,David P. Faxon,Rizwan Afzal,Susan Chrolavicius,Sanjit S. Jolly,Petr Widimsky,Alvaro Avezum,Hans-Jürgen Rupprecht,Jun Zhu,Jacques Col,Madhu K. Natarajan,Craig Horsman,Keith A.A. Fox,Salim Yusuf +17 more
TL;DR: Early intervention did not differ greatly from delayed intervention in preventing the primary outcome, but it did reduce the rate of the composite secondary outcome of death, myocardial infarction, or refractory ischemia and was superior to delayed Intervention in high-risk patients.
Journal Article
[Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban].
M Galli,C Vassanelli +1 more
Journal ArticleDOI
Immediate vs delayed intervention for acute coronary syndromes: a randomized clinical trial.
Gilles Montalescot,Guillaume Cayla,Jean-Philippe Collet,Simon Elhadad,Farzin Beygui,Hervé Le Breton,Rémi Choussat,Florence Leclercq,Johanne Silvain,Francois Duclos,Mounir Aout,Jean-Luc Dubois-Randé,Olivier Barthelemy,Gregory Ducrocq,Anne Bellemain-Appaix,Laurent Payot,Philippe-Gabriel Steg,Patrick Henry,Christian Spaulding,Eric Vicaut +19 more
TL;DR: In patients with acute coronary syndromes without ST-segment elevation, a strategy of immediate intervention compared with an intervention deferred to the next working day did not result in a difference in myocardial infarction as defined by peak troponin level.
Immediate vs Delayed Intervention for Acute Coronary Syndromes
Gilles Montalescot,Guillaume Cayla,Jean-Philippe Collet,Simon Elhadad,Farzin Beygui,Florence Leclercq,Johanne Silvain,Mounir Aout,Anne Bellemain-Appaix,Laurent Payot,Philippe-Gabriel Steg,Patrick Henry,Christian Spaulding,Eric Vicaut +13 more
Journal ArticleDOI
Age-specific gender differences in in-hospital mortality by type of acute myocardial infarction.
TL;DR: Higher risk of in-hospital mortality in younger women compared to younger men is more evident in patients with STEMI; however, older women (≥70 years old) had better survival than men.
References
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Journal ArticleDOI
Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban.
Christopher P. Cannon,William S. Weintraub,Laura A. Demopoulos,Ralph Vicari,Martin J. Frey,Nasser Lakkis,Franz-Josef Neumann,Debbie H. Robertson,Paul DeLucca,Peter M. DiBattiste,C. Michael Gibson,Eugene Braunwald +11 more
TL;DR: In patients with unstable angina and myocardial infarction without ST-segment elevation who were treated with the glycoprotein IIb/IIIa inhibitor tirofiban, the use of an early invasive strategy significantly reduced the incidence of major cardiac events.
Journal ArticleDOI
Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes
J.-P Bassand,Christian W. Hamm,Diego Ardissino,Eric Boersma,A Budaj,Francisco Fernández-Avilés,Keith A.A. Fox,David Hasdai,Erik Magnus Ohman,Lars Wallentin,William Wijns +10 more
TL;DR: Guidelines and Expert Consensus Documents summarize and evaluate all currently available evidence on a particular issue with the aim to assist physicians in selecting the best management strategies for a typical patient, suffering from a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means.
Journal ArticleDOI
Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC II prospective randomised multicentre study
TL;DR: Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC II prospective randomised multicentre study finds no significant difference in survival or morbidity between the two treatment options.
Journal ArticleDOI
Interventional versus conservative treatment for patients with unstable angina or non-ST-elevation myocardial infarction: the British Heart Foundation RITA 3 randomised trial
Keith A.A. Fox,Philip A. Poole-Wilson,Robert A. Henderson,Tim Clayton,D. Chamberlain,T. R. D. Shaw,D J Wheatley,Stuart J. Pocock +7 more
TL;DR: In this paper, a randomized multicentre trial of 1810 patients with non-ST-elevation acute coronary syndromes (mean age 62 years, 38% women) was conducted, where patients were assigned an early intervention or conservative strategy.
Journal ArticleDOI
Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology
TL;DR: ‘Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes’ recently published in European Heart Journal 1 rightly dedicates space to the pitfalls that can be encountered when reading presentation ECGs, but there is an important omission.
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