Abstract
Introduction and aimsPatients with non-ST-elevation acute coronary syndrome (NSTE-ACS) are often managed conservatively. Clinical practice guidelines recommend treating these patients with the same pharmacological drugs as those who receive invasive treatment. We analyze the use of new antiplatelet drugs (NADs) and other recommended treatments in people discharged following an NSTE-ACS according to the treatment strategy used, comparing the medium-term prognosis between groups.MethodsProspective observational multicenter registry study in 1717 patients discharged from hospital following an ACS; 1143 patients had experienced an NSTE-ACS. We analyzed groups receiving the following treatment: No cardiac catheterization (NO CATH): n = 134; 11.7%; Cardiac catheterization without revascularization (CATH-NO REVASC): n = 256; 22.4%; percutaneous coronary intervention (PCI): n = 629; 55.0%; and coronary artery bypass graft (CABG): n = 124; 10.8%. We assessed major adverse cardiovascular events (MACE), all-cause mortality, and hemorrhagic complications at one year.ResultsNO CATH was the oldest, had the most comorbidities, and was at the highest risk for ischemic and hemorrhagic events. Few patients who were not revascularized with PCI received NADs (NO CATH: 3.7%; CATH-NO REVASC: 10.6%; PCI: 43.2%; CABG: 3.2%; p<0.001). Non-revascularized patients also received fewer beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB), and statins (p<0.001). At one year, MACE incidence in NO CATH group was three times that of the other groups (30.1%, p<0.001), and all-cause mortality was also much higher (26.3%, p<0.001). There were no significant differences in hemorrhagic events. Belonging to NO CATH group was an independent predictor for MACE at one year in the multivariate analysis (HR 2.72, 95% CI 1.29–5.73; p = 0.008).ConclusionsDespite current invasive management of NSTE-ACS, patients not receiving catheterization are at very high risk for under treatment with recommended drugs, including NADs. Their medium-term prognosis is poor, with high mortality. Patients treated with PCI receive better pharmacological management, with high use of NADs.
Highlights
Introduction and aimsPatients with non-ST-elevation acute coronary syndrome (NSTE-ACS) are often managed conservatively
Few patients who were not revascularized with percutaneous coronary intervention (PCI) received new antiplatelet drugs (NADs) (NO CATH: 3.7%; CATH-NO REVASC: 10.6%; PCI: 43.2%; coronary artery bypass graft (CABG): 3.2%; p
Belonging to No cardiac catheterization (NO CATH) group was an independent predictor for major adverse cardiovascular events (MACE) at one year in the multivariate analysis (HR 2.72, 95% CI 1.29–5.73; p = 0.008)
Summary
Introduction and aimsPatients with non-ST-elevation acute coronary syndrome (NSTE-ACS) are often managed conservatively. Several studies report that the population who does not undergo coronary catheterization is a high-risk group, with higher comorbidities and incidence of cardiovascular events in the medium and long term [3,4] Despite this high risk, different studies have shown that patients who receive medical treatment alone are often undertreated pharmacologically, i.e., a lower proportion of these patients followed the optimal recommended drug treatment compared to those who are revascularized [5,6]. The CURE study found that at one-year follow-up, the NSTE-ACS patients receiving dual antiplatelet therapy (DAPT, aspirin plus clopidogrel) presented lower combined rates of cardiovascular death, myocardial infarction, and stroke compared to those taking aspirin alone [7] This reduction in cardiovascular risk was similar in patients treated medically and in those who received revascularization therapy. While most patients who undergo an angioplasty continue their treatment with DAPT, less than half of those treated medically are discharged with a second antiplatelet agent, even though both groups can achieve similar benefits [3]
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