Author + information
- Philippe Steg,
- Etienne Puymirat,
- Emmanuel Sorbets,
- Laurent J. Feldman,
- Meyer Elbaz,
- Bernard Ritz,
- Arnaud Hueber,
- Tabassome Simon and
- Nicolas Danchin
: Patients with Non-ST Elevation Acute myocardial infarction (NSTEMI) may be managed by revascularization or medical therapy. Medically managed NSTEMI patients have attracted interest recently. We hypothesized that this is a heterogenous population based on whether medical management was decided without angiography (patients at too low risk to warrant or too sick to undergo angiography) or after angiography (patients with minimal disease or too severe disease to be amenable to revascularization).
: We analyzed 1798 NSTEMI patients from a nationwide registry collected in 223 centers in 2005. Patients treated with percutaneous or surgical revascularization were excluded from analysis. Patients were categorized according to whether they underwent coronary angiography or not and, for those who did, according to the presence of no/minimal CAD, single (1D), double (2D) or triple vessel disease (3D).
: Baseline demographics, and Grace Score differed among groups (Table). While the overall mortality at 5 years was 43.9%, it diverged markedly among groups (63% with no angio and 9%, 18.4%, 36.8% and 39.4% in patients with no CAD, 1D, 2D, 3D respectively (p<0.001).
|No angio (n=383)||no significant CAD (n=111)||1-VD (n=98)||2-VD (n=57)||3-VD (n=94)|
|Age ± SD (years)||80 ± 10||65 ± 14||67 ± 12||71 ± 9||72 ± 11|
|Women||51 %||46 %||32%||33%||36%|
|GRACE risk score||178 ± 32||129 ± 34||141 ± 42||155 ± 32||153 ± 36|
|5 year mortality||62.7%||9.0%||18.4%||36.8%||39.4%|
: Medically managed NSTEMI patients represent a higly heterogenous group in terms of baseline characteristics and outcomes. The highest risk patients are those who do not undergo angiography, with 5-year mortality far exceeding those pts with triple vessel disease who did not undergo revascularization.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Acute Coronary Syndromes: Clinical Outcomes
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1299-175
- 2013 American College of Cardiology Foundation