Early Invasive Versus Selective Strategy for Non–ST-Segment Elevation Acute Coronary Syndrome

Hoedemaker, N.P.G.; Damman, Peter; Woudstra, Pier; Hirsch, Alexander; Janus, C; Umans, Victor; Bendermacher, Peter E.F.; Sadee, Arthur S.J.M.; Hertzberger, D.P.; Peters, Ron J.G.; Miliano, P.A.R.M. de; Liem, Anho; Gin, R. Tjon Joe; Linde, Maarten van der; Lok, Dirk J.; Hoedemaker, G.; Pieterse, M; Merkhof, L. van den; Daniels, Matthew J.; Hessen, Maarten van; Hermans, W R M; Schotborgh, Carl E.; Zwaan, Chris de; Bredero, Ad C.; Jaegere, Peter de; Janssen, Marcel J.W.; Louwerenburg, J. W.; Veerhoek, M. J.; Schalij, Martin J.; Porto, Alizée; Zijlstra, Felix; Winter, José Luis; Feyter, Pim de; Medina, R. Robles de; Withagen, P.J.; Sedney, M. I.; Thijssen, H.O.M.; Rees, C. van; Bergh, P. van den; Cock, CC De; Hof, Arnoud van ’t; Suttorp, Maarten-Jan; Cornel, Jan H.; Verheugt, Freek W.A.; Dunselman, Peter H.J.M.; Feyter, Pim J. de; Michels, H. R.; Winter, Robbert J. de; Windhausen, Fons; Tijssen, Jan G.P.; Düren, Donald R.; Liem, Koen L.; Sanders, Gerard T.; Fischer, Johan; Straalen, Jan van

doi:10.1016/j.jacc.2017.02.023

Cited by 35 publications

(30 citation statements)

References 24 publications

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“…There remains a substantial opportunity to improve ACS outcomes especially in high-risk patients. An aggressive approach to ACS and AF management, including selective elective strategy, optimal use of P2Y12 inhibitor and non-vitamin K antagonist oral anticoagulant, or timely rhythm conversion is justified and should be balanced with the risk associated with aging and co-morbidity [ 28 – 30 ]. There is a growing need for randomized controlled trial data to be more representative of the elderly patients or patients with multiple co-morbidities.…”

Section: Discussionmentioning

confidence: 99%

Adverse Outcomes Associated with Pre-Existing and New-Onset Atrial Fibrillation in Patients with Acute Coronary Syndrome: A Retrospective Cohort Study

et al. 2019

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Introduction Atrial fibrillation (AF) often occurs in patients with acute coronary syndrome (ACS). It remains unclear whether pre-existing or new-onset AF confers different risk in patients with ACS. Methods We conducted a retrospective cohort study using Taiwan’s National Health Insurance Research Database. Patients who were hospitalized with a primary diagnosis of ACS from 2005 to 2009 were studied. Major outcomes were mortality, heart failure, and combined ischemic stroke/systemic embolism (IS/SE). The date of the first ACS diagnosis was defined as the index date. Pre-existing AF was defined as AF occurring before the index date. New-onset AF was defined as AF that started after or at the same time as the ACS diagnosis. Results Among 6663 patients with ACS, 488 (7.3%) had pre-existing AF and 479 (7.2%) had new-onset AF. Compared to patients with pre-existing AF, those with new-onset AF were younger, less likely to have co-morbidities, and more likely to receive evidence-based therapy. The un-adjusted risks of adverse outcomes in both groups were similar. Compared to pre-existing AF, new-onset AF was significantly associated with a higher adjusted risk of death (hazard ratio 1.27, 95% confidence interval 1.06–1.52) and IS/SE (hazard ratio 1.49, 95% confidence interval 1.01–2.20). The significant associations between new-onset AF and adverse outcomes were more likely to be observed in elderly patients with ACS. Conclusions New-onset AF during ACS was associated with a significantly increased risk of adverse outcomes, especially in the elderly patients.

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Section: Discussionmentioning

confidence: 99%

Adverse Outcomes Associated with Pre-Existing and New-Onset Atrial Fibrillation in Patients with Acute Coronary Syndrome: A Retrospective Cohort Study

et al. 2019

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“…Several other trials also showed no significant effect in cardiovascular outcome [19][20][21]. Importantly, one of the largest of these trials [20] established a significant reduction in the combined endpoint of death MI and stroke at 6 months for patients with the highest risk defined as having a GRACE score N 140, an effect that was lost at 10-year follow-up [22].…”

Section: Discussionmentioning

confidence: 99%

Invasive treatment of NSTEMI patients in German Chest Pain Units – Evidence for a treatment paradox

Schmidt

Schmitt

Hochadel

et al. 2018

International Journal of Cardiology

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“…These findings are consistent with a previous Cochrane analysis published in 2016 [ 3 ]. However, this prior analysis did not include the new long-term data from the FRISC-II [ 4 ], RITA-3 [ 5 ] and ICTUS [ 6 ] trials, which have been published recently.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Geography on Outcomes of Routine Early Versus Selective Late Revascularization Strategy in the Treatment of Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Transatlantic Randomized Controlled Trials

Virk

Krittanawong

et al. 2018

J Clin Med Res

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BackgroundThe optimal timing of revascularization in unstable angina (UA) or non-ST-segment elevation myocardial infarction (NSTEMI) remains uncertain. We compared routine early revascularization (REV) versus selective late revascularization (SLR) strategies and divergence in the approach of cardiologists in the United States and Europe.MethodsSeventeen randomized controlled trials (RCTs) (15,812 patients) were extracted from PubMed, Cochrane Library, EMBASE and Web of Science databases. The data were pooled using the Der Simonian and Laird random-effect models and expressed as pooled risk ratios (RR) with 95% confidence intervals (95% CIs).ResultsOverall, there was no difference in all-cause mortality (RR: 1.01, 95% CI: 0.95 - 1.08, P = 0.7), myocardial infarction (MI) (RR: 0.98, 95% CI: 0.79 - 1.22, P = 0.85) or coronary artery bypass grafting (CABG) (RR: 1.33, 95% CI: 0.92 - 1.91, P = 0.12) between REV and SLR strategy. There were trends of decreased incidence of MI in REV, 13.3% (1,029/7,704) vs. 15.1% (1,108/7,314) in SLR (P = 0.007), and rate of CABG was higher in REV, 4.9% (140/2,831) vs. 3.7% (105/2,819) in SLR (P = 0.031). There were trends of lower all-cause mortality in the combined US/international trials in both REV 8.4% (390/4,624) vs. 22.8% (908/3,975) (P < 0.001) and SLR 8% (359/4,421) vs. 24% (910/3,808) (P < 0.001) compared to the European trials. There were also trends of lower rates of MI in the European trials in the REV group 20% (623/3,080) vs. 25% (712/2,893) in SLR (P = 0.001) and higher rates of CABG in REV 8.3% (96/1,144) vs. 5.7% (67/1,165) in SLR (P = 0.02); however, there were no significant effects in the pooled RR ratios even after subgroup analysis between US/international trials and European trials.ConclusionsDespite having contemporary differences in the management approach towards UA/NSTEMI patients, no significant differences in trends were observed with REV strategy in US/international trials vs. European trials.

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Early Invasive Versus Selective Strategy for Non–ST-Segment Elevation Acute Coronary Syndrome

Cited by 35 publications

References 24 publications

Adverse Outcomes Associated with Pre-Existing and New-Onset Atrial Fibrillation in Patients with Acute Coronary Syndrome: A Retrospective Cohort Study

Adverse Outcomes Associated with Pre-Existing and New-Onset Atrial Fibrillation in Patients with Acute Coronary Syndrome: A Retrospective Cohort Study

Invasive treatment of NSTEMI patients in German Chest Pain Units – Evidence for a treatment paradox

The Effects of Geography on Outcomes of Routine Early Versus Selective Late Revascularization Strategy in the Treatment of Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Transatlantic Randomized Controlled Trials

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