Early invasive versus early conservative strategy in non-ST-elevation acute coronary syndrome: An outcome research study

Tubaro, Marco; Sciahbasi, Alessandro; Ricci, Roberto; Ciavolella, Massimo; Clemente, D. Di; Bisconti, Carmela; Ferraiuolo, Giuseppe; Pinto, Maurizio Del; Mennuni, Mauro; Monti, Francesco; Vinci, Eugenio; Semeraro, Raffaella; Greco, Cesare; Berti, Sérgio; Romanò, Carlo Luca; Aiello, Alessandro; Bianco, Francesco; Pellecchia, Raffaele; Azzolini, Paolo; Ciuffetta, Domenico; Zappulo, Renato; Gigantino, Alberto; Arima, Susumu; Colivicchi, Furio; Santini, Massimo

doi:10.1177/2048872615590145

Cited by 6 publications

(4 citation statements)

References 75 publications

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“…(8) Elevation variation coefficient Elevation variation coefficient (Figure 2h) can be expressed as the ratio of the standard deviation of elevations to their average value in a certain area. This terrain factor is in direct proportion to the terrain complexity [52,53].…”

Section: ) Elevationmentioning

confidence: 99%

Regional Terrain Complexity Assessment Based on Principal Component Analysis and Geographic Information System: A Case of Jiangxi Province, China

Huang

Yang

Zhang

et al. 2020

IJGI

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Regional terrain complexity assessment (TCA) is an important theoretical foundation for geological feature identification, hydrological information extraction and land resources utilization. However, the previous TCA models have many disadvantages; for example, comprehensive consideration and redundancy information analysis of terrain factors is lacking, and the terrain complexity index is difficult to quantify. To overcome these drawbacks, a TCA model based on principal component analysis (PCA) and a geographic information system (GIS) is proposed. Taking Jiangxi province of China as an example, firstly, ten terrain factors are extracted using a digital elevation model (DEM) in GIS software. Secondly, PCA is used to analyze the information redundancy of these terrain factors and deal with data compression. Then, the comprehensive evaluation of the compressed terrain factors is conducted to obtain quantitative terrain complexity indexes and a terrain complexity map (TCM). Finally, the TCM produced by the PCA method is compared with those produced by the slope-only, the variation coefficient and K-means clustering models based on the topographic map drawn by the Bureau of Land and Resources of Jiangxi province. Meanwhile, the TCM is also verified by the actual three-dimensional aerial images. Results show that the correlation coefficients between the TCMs produced by the PCA, slope-only, variable coefficient and K-means clustering models and the local topographic map are 0.894, 0.763, 0.816 and 0.788, respectively. It is concluded that the TCM of the PCA method matches well with the actual field terrain features, and the PCA method can reflect the regional terrain complexity characteristics more comprehensively and accurately when compared to the other three methods.

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Section: ) Elevationmentioning

confidence: 99%

Regional Terrain Complexity Assessment Based on Principal Component Analysis and Geographic Information System: A Case of Jiangxi Province, China

Huang

Yang

Zhang

et al. 2020

IJGI

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“…Ongoing medical care must be continued until stabilization of higher risk features with conservative therapy as the mean age of the patients in the study is relatively high. These patients take a great benefit from a more aggressive antiplatelet and antithrombotic regimen and an early invasive strategy than the patients with a lower risk (Hoedemaker et al, 2017, Tubaro et al, 2017.…”

Section: Table 2: Electrocardiographic and Echocardiographic Findingsmentioning

confidence: 99%

Dr. Risk Stratification and Clinical Eligibility of Invasive vs. Noninvasive Strategy in the Management of Non-ST Elevation Acute Coronary Syndrome Patients Admitted to Hawler Teaching Hospital

2018

ZJPAS

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Background and objectives:The term acute coronary syndrome (ACS) is a range of acute myocardial ischemic states including unstable angina (UA), non-ST segment (NSTE), and ST-segment elevation myocardial infarction (STEMI). It is required to identify the cardiovascular events risk in those patients in order to select the beneficial therapeutic strategy during the first hours of presentation. The aim of the present study is to stratify the cardiac event risk and to determine the clinical eligibility of invasive vs. noninvasive therapeutic strategy in patients presented with UA and NSEMI as defined as NSTE-ACS. Methods:In the current observational cross-sectional study, 100 consecutive patients who visited the emergency department and admitted to coronary care unit diagnosed as NSTE-ACS were recruited. Their medical and clinical information were obtained from the patient and medical records. The cardiac event risk was estimated according to the GRACE risk score (Global Registry of Acute Coronary Events) and the TIMI risk score (Thrombolysis in Myocardial Infarction). The clinical eligibility of invasive vs. noninvasive (Ischemia-guided) therapeutic strategy was determined according to the latest AHA/ACC guideline for the management of patients with NSTE-ACS in 2014. Results:Of patients presented with NSTE-ACS who underwent both therapeutic strategies most of them were males (71.0%). The mean ± S.D. was 60-62 years for age. The mean ± S.D. of body mass index (BMI), chest pain duration, systolic blood pressure and heart rate were comparable in two groups. In terms of clinical characteristics hypertension (72.0%), current smoking (56.0%), dyslipidemia (48.0%), and past history of coronary artery disease (CAD) (44.0%) were the most prevalent. Patients who underwent invasive strategy had significantly more ST-depression (75.6%) as compared to those who underwent non-invasive strategy (55.9%), P=0.044. However, non-invasive group had significantly more T-wave inversion, (59.3% vs. 34.1%; P=0.013). The studied groups showed no statistically significant difference in risk of mortality according to GRACE risk score (P=0.505), TIMI risk score (P=0.057), and Killip class (P=0.252). However, the majority of non-invasive group had low risk (67.8%) while, the invasive group more common to be at intermediate risk (29.3%) for 6-month mortality. There was no statistically significant predictor of two therapeutic strategies according to the patients characteristics and risk stratification (p>0.05).

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“…In an Italian registry, an early invasive strategy provided no benefit in outcome compared to an early conservative strategy performed at non-PCI capable hospitals intriguingly independent of the GRACE risk score. 2 However, on per protocol analysis an early invasive strategy was superior indicating that cardiologists are very able to clinically risk stratify patients for early transfer to a PCI-capable hospital. On the other hand, the decision to perform early coronary angiography can already be taken in the pre-hospital setting based on the EKG and point of care troponin measurement as is demonstrated by a preliminary report from the in Denmark ongoing randomized acute versus subacute angioplasty in patients with NON-ST-Elevation Myocardial Infarction (NONSTEMI) trial.…”

mentioning

confidence: 99%

Non-ST elevation acute coronary syndromes: timing and selection of early invasive management, ECG monitoring need, DAPT duration, pathogenesis of recurrence and beware of delirium in the intensive/acute cardiac care unit!

Vrints

2017

European Heart Journal: Acute Cardiovascular Care

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Early invasive versus early conservative strategy in non-ST-elevation acute coronary syndrome: An outcome research study

Abstract: In a real-life registry of all-comers NSTEACS patients, ECS was non-inferior to EIS; however, when EIS was applied according to clinical judgement, a reduction of clinical events at one year was demonstrated.

Cited by 6 publications

References 75 publications

Regional Terrain Complexity Assessment Based on Principal Component Analysis and Geographic Information System: A Case of Jiangxi Province, China

Regional Terrain Complexity Assessment Based on Principal Component Analysis and Geographic Information System: A Case of Jiangxi Province, China

Dr. Risk Stratification and Clinical Eligibility of Invasive vs. Noninvasive Strategy in the Management of Non-ST Elevation Acute Coronary Syndrome Patients Admitted to Hawler Teaching Hospital

Non-ST elevation acute coronary syndromes: timing and selection of early invasive management, ECG monitoring need, DAPT duration, pathogenesis of recurrence and beware of delirium in the intensive/acute cardiac care unit!

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