Purpose: Patients with acute coronary syndrome (ACS) do not necessarily undergo coronary angiography and are managed acutely in a noninvasive manner. We investigate how soon evidence based secondary prevention therapies should be started after an ACS in this population. Methods: The study populations consisted of 8214 ACS patients, of these 4156 patients (42.0% non ST-elevation (STE) ACS and 58.0% STE-ACS patients) that did not received reperfusion treatment. Patients were admitted at 57 hospitals reporting data to the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) registry (ClinicalTrials.gov, NCT01218776), from October 2010 to February 2014. We assessed the use of beta-blockers, statins and angiotensin-converting enzyme inhibitors in the emergency setting, (within 24 hrs since hospital admission) and their effects on in-hospital incidence of death. Results: There were 2451 patients that received all 3 drugs in the emergency setting (group 3), 982 patients with 2 medications (group 2), 384 patients with 1 medication (group 1) and 252 patients that did not receive any drugs (group 0). The mortality rate was 4.8%, 11.1%, 29.2% and 65.7% in group 3, 2, 1 and 0, respectively. Benefits were observed both in non STE-ACS (incidence of mortality: 3.0%, 9.0%, 19.7%, and 58.7%, in group 3, 2, 1 and 0, respectively) and in STE-ACS (incidence of mortality: 6.1%, 13.1%, 34.7%, and 68.8% in group 3, 2, 1 and 0, respectively). The advantage of multiple combination of prevention therapies was confirmed by multivariable analysis. The absolute risk reduction was of greater magnitude and statistical significance (p<0.001) in those patients with non STE-ACS (adjusted OR: 0.11, 95%CI: 0.04-0.26) than in those with STE-ACS (adjusted OR: 0.07, 95%; 0.04-0.11). Conclusions: Concomitant use of secondary prevention therapies in the emergency setting is associated with reduced of in-hospital mortality for those ACS patients not undergoing invasive workup.
Medical therapies in the emergency setting of patients not undergoing invasive workup / B. Ricci; E. Cenko; Z. Vasiljevic; M. Dorobantu; S. Kedev; B. Knezevic; D. Milicic ; O. Manfrini; L. Badimon; R. Bugiardini. - In: EUROPEAN HEART JOURNAL. - ISSN 1522-9645. - ELETTRONICO. - 35:Abstract Supplement(2014), pp. 481-481. [10.1093/eurheartj/ehu323]
Medical therapies in the emergency setting of patients not undergoing invasive workup
RICCI, BEATRICE;CENKO, EDINA;MANFRINI, OLIVIA;BUGIARDINI, RAFFAELE
2014
Abstract
Purpose: Patients with acute coronary syndrome (ACS) do not necessarily undergo coronary angiography and are managed acutely in a noninvasive manner. We investigate how soon evidence based secondary prevention therapies should be started after an ACS in this population. Methods: The study populations consisted of 8214 ACS patients, of these 4156 patients (42.0% non ST-elevation (STE) ACS and 58.0% STE-ACS patients) that did not received reperfusion treatment. Patients were admitted at 57 hospitals reporting data to the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) registry (ClinicalTrials.gov, NCT01218776), from October 2010 to February 2014. We assessed the use of beta-blockers, statins and angiotensin-converting enzyme inhibitors in the emergency setting, (within 24 hrs since hospital admission) and their effects on in-hospital incidence of death. Results: There were 2451 patients that received all 3 drugs in the emergency setting (group 3), 982 patients with 2 medications (group 2), 384 patients with 1 medication (group 1) and 252 patients that did not receive any drugs (group 0). The mortality rate was 4.8%, 11.1%, 29.2% and 65.7% in group 3, 2, 1 and 0, respectively. Benefits were observed both in non STE-ACS (incidence of mortality: 3.0%, 9.0%, 19.7%, and 58.7%, in group 3, 2, 1 and 0, respectively) and in STE-ACS (incidence of mortality: 6.1%, 13.1%, 34.7%, and 68.8% in group 3, 2, 1 and 0, respectively). The advantage of multiple combination of prevention therapies was confirmed by multivariable analysis. The absolute risk reduction was of greater magnitude and statistical significance (p<0.001) in those patients with non STE-ACS (adjusted OR: 0.11, 95%CI: 0.04-0.26) than in those with STE-ACS (adjusted OR: 0.07, 95%; 0.04-0.11). Conclusions: Concomitant use of secondary prevention therapies in the emergency setting is associated with reduced of in-hospital mortality for those ACS patients not undergoing invasive workup.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
