Invasive strategy in non-ST-segment elevation acute coronary syndrome: What should be the benchmark target in the real world patients? Insights from BLITZ-4 Quality Campaign

Olivari, Zoran; Chinaglia, Alessandra; Gonzini, Lucio; Falsini, Giovanni; Pilleri, Annarita; Valente, Serafina; Gregori, Gianserafino; Rollo, Raffaele; My, Luigi; Scrimieri, Pietro; Lanzillo, Tonino; Corrado, Luigi; Chiti, M.; Picardi, Elisa

doi:10.1016/j.ijcard.2016.06.089

Cited by 6 publications

(3 citation statements)

References 34 publications

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“… 46 Performing CAG is another critical factor that plays a part in the initiation of secondary prevention drugs. 7 , 47 , 48 A significant proportion of both study populations were assigned a conservative strategy, a proportion similar to other studies on MI and stable CAD. 32 , 35 , 37 , 42 , 47 , 48 …”

Section: Discussionmentioning

confidence: 90%

“…As in previous studies, 7 , 42 , 43 these patients also appeared to be older and with greatest co-morbidity burden, crucial factors that are usually considered in the risk benefit analysis of an invasive strategy. 47 , 48 While some found conservative strategy as being clinically justifiable, 47 others showed that the risk profile has been underestimated, 49 indicating a risk-treatment mismatch where high-risk patients have a lower likelihood to receive CAG, 40 , 42 even though the benefit of an invasive strategy increases with baseline risk. 50 …”

Section: Discussionmentioning

confidence: 99%

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Coronary artery disease severity and long-term cardiovascular risk in patients with myocardial infarction: a Danish nationwide register-based cohort study

Özcan

Deleskog

Olsen

et al. 2017

European Heart Journal - Cardiovascular Pharmacotherapy

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AimLong-term prognostic impact of coronary artery disease (CAD) severity in stable post-myocardial infarction (MI) patients is not well known. We examined the impact of CAD severity and co-morbidity on the long-term (1 year and beyond) risk of cardiovascular events post-MI.Methods and resultsFrom nationwide administrative and clinical registers, we identified 55 747 MI patients, during 2004–2010, who had not experienced subsequent MI, stroke, or death within 7 days post-discharge. The risk for primary composite endpoint (MI, stroke, or cardiovascular death) was estimated for the first 365 days after MI (index MI) and from day 366 to study completion (stable post-MI population), corresponding to a mean follow-up of 3.6 (2.2) years. Risk was assessed using cumulative incidence, multivariable adjusted logistic regression and Cox proportional-hazards models. The 1-year cumulative incidence for primary endpoint was 20.0% [95% confidence interval (CI), (19.6–20.3)]. Correspondingly, the 4-year cumulative incidence for primary endpoint was 21.0% (95% CI, 20.6–21.4) in patients without events on the first year. In multivariable models with no significant stenosis as reference, CAD severity was the most important risk factor for cardiovascular events the first 365 days [left main stenosis (LMS): odds ratio and 95% CI, 4.37, 3.69–5.17; 3-vessel disease (VD), 4.18, 3.66–4.77; 2-VD, 3.23, 2.81–3.72; 1-VD, 2.12,–1.85–2.43] and remained from day 366 to study completion [LMS: hazard ratio and 95% CI, 1.91, 1.64–2.22; 3-VD, 1.85,1.65–2.07; 2-VD, 1.55, 1.38–1.74; 1-VD, 1.30, 1.16–1.45].ConclusionDespite contemporary treatment at baseline, stable post-MI patients’ 4-year outcome was similar to 1-year outcome after MI, and CAD severity remained a critical risk factor the first year and thereafter.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Coronary artery disease severity and long-term cardiovascular risk in patients with myocardial infarction: a Danish nationwide register-based cohort study

Özcan

Deleskog

Olsen

et al. 2017

European Heart Journal - Cardiovascular Pharmacotherapy

View full text Add to dashboard Cite

show abstract

“…A study from BLITZ-4 registry also addressed this issue and tried to establish a reasonable target for invasive strategy, where 85% was considered as the benchmark target for the treatment of consecutive patients with NSTE-ACS. [ 15 ] In that study, patient refusal was the second common cause (21%) among reasons driving the choice for conservative strategy.…”

Section: Discussionmentioning

confidence: 96%

The rate of coronary angiography refusal in older patients with non-ST elevation acute coronary syndrome and its impact on all-cause mortality

Keskin¹

2021

Sisli Etfal

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Objectives: Significant number older patients with acute coronary syndrome (ACS) cannot undergo coronary angiography (CAG) due to various comorbidities. Patient’s refusal of invasive procedures is common among old patients and has not been thoroughly investigated in the context of ACS. We wanted to assess CAG refusal rate and its impact on all-cause mortality in older patients with non-ST elevation acute myocardial infarction. Methods: In this retrospective study, patients over 75 years of age admitted with acute non-ST elevation ACS were included in the study. Patients were divided into three groups based on the treatment strategy; Group 1: Those who underwent CAG; Group 2: Refused; and Group 3: Deemed unsuitable for procedure due to severe comorbidities. The primary outcomes were to assess the patient refusal rate and its impact on all-cause mortality. Results: The study included 201 elderly patients. Eighty-two (41%) patients did not undergo CAG and of those, 48 (24%) had severe comorbidities, and 34 (17%) refused the procedure. The in-hospital mortality for patients who underwent, refused, or could not undergo CAG was 5.0%, 0%, and 16.7% (p<0.01); 30-day mortality 8.5%, 9.1%, and 25% (p=0.01); and long-term mortality was 20.2%, 35.3%, and 47.9% (p<0.01), respectively. The median follow-up was 12 months. Hazard ratio of treatment refusal for long-term mortality was 1.97 (1.02–3.87, 95% CI). Conclusion: Substantial number of elderly patients with ACS refuses to undergo CAG and this leads to increased mortality. Factors affecting patient behavior and the decision-making process should be explored.

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Association of Beta-Blockers with Survival on Patients Presenting with ACS Treated with PCI: A Propensity Score Analysis from the BleeMACS Registry

D’Ascenzo

Celentani

Brustio

et al. 2018

Am J Cardiovasc Drugs

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Invasive strategy in non-ST-segment elevation acute coronary syndrome: What should be the benchmark target in the real world patients? Insights from BLITZ-4 Quality Campaign

Cited by 6 publications

References 34 publications

Coronary artery disease severity and long-term cardiovascular risk in patients with myocardial infarction: a Danish nationwide register-based cohort study

Coronary artery disease severity and long-term cardiovascular risk in patients with myocardial infarction: a Danish nationwide register-based cohort study

The rate of coronary angiography refusal in older patients with non-ST elevation acute coronary syndrome and its impact on all-cause mortality

Association of Beta-Blockers with Survival on Patients Presenting with ACS Treated with PCI: A Propensity Score Analysis from the BleeMACS Registry

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