012: Use of invasive strategy in non-ST-elevation myocardial infarction is a major determinant of improved long-term survival. The FAST-MI registry

Abstract

We assessed the impact of invasive strategy (IS) versus a conservative strategy (CS) on in-hospital complications and three-year outcomes in patients with Non-ST-Elevation Myocardial Infarction (NSTEMI) from the FAST-MI registry. Results from randomized trials comparing IS and CS in patients with NSTEMI are conflicting. Of the 3,670 patients in the FAST-MI registry, which included patients with acute myocardial infarction (within 48 hours) over a one-month period in France at the end of 2005, 1,645 presented with NSTEMI. Of the 1,645 patients analyzed, 80% had an IS. Patients in the IS group were younger (67±12 vs. 80±11 years), less often women (29% vs. 51%) and had a lower GRACE risk score (137±36 vs. 178±34) as compared with patient treated with CS. In-hospital mortality and blood transfusions were significantly more frequent in patients with CS as compared with IS (13.1 vs. 2.0%, 9.1 vs. 4.6%). Use of IS was associated with a significant reduction in 3-year mortality and cardiovascular death (17% vs. 60%, adjusted HR: 0.44; 95%CI: 0.35-0.55 and 8% vs. 36%, adjusted HR: 0.37; 95%CI: 0.27-0.50). After propensity score matching (181 patients per group), 3-year survival was significantly higher in patients treated with IS. In a real-world setting of patients admitted with NSTEMI, the use of IS during the initial hospital stay is an independent predictor of improved 3-year survival, regardless of age.