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.
B. Ricci, E. Cenko, Z. Vasiljevic, M. Dorobantu, S. Kedev, B. Knezevic, et al. (2014). Medical therapies in the emergency setting of patients not undergoing invasive workup. EUROPEAN HEART JOURNAL, 35(Abstract Supplement), 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.
