2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes: Executive Summary

Amsterdam, Ezra A.; Wenger, Nanette K.; Brindis, Ralph G.; Casey, Donald E.; Ganiats, Théodore G.; Holmes, David R.; Jaffe, Allan S.; Jneid, Hani; Kelly, Rosemary F.; Kontos, Michael C.; Levine, Glenn N.; Liebson, Philip R.; Mukherjee, Debabrata; Peterson, Eric D.; Sabatine, Marc S.; Smalling, Richard W.; Zieman, Susan J.

doi:10.1161/cir.0000000000000133

Cited by 937 publications

(341 citation statements)

References 351 publications

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“…In accordance with this previous report, the overall ACS admission was associated with an increased risk of long‐term mortality in our study. Recent guidelines, however, do not necessarily put much emphasis on discriminating between UA and MI events from a clinical perspective (especially in the event of a non‐ST‐elevation MI),20 but the GRACE investigators also demonstrated minimal association between UA admission and subsequent mortality as compared with an MI admission and long‐term death 19. Our findings are congruent with this observation.…”

Section: Discussionsupporting

confidence: 86%

Prognostic Impact of Subsequent Acute Coronary Syndrome and Unplanned Revascularization on Long‐Term Mortality After an Index Percutaneous Coronary Intervention: A Report From a Japanese Multicenter Registry

Inohara

Kohsaka

Matsubara

et al. 2017

JAHA

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BackgroundWhereas composite end points are often used in clinical trials of percutaneous coronary interventions (PCI), the impact of individual components on subsequent survival is incompletely defined. We evaluated the association of subsequent acute coronary syndromes (ACS) and unplanned coronary revascularization post‐PCI with long‐term survival.Methods and ResultsFrom 2009 to 2011, the KiCS‐PCI (Keio interhospital Cardiovascular Studies) consecutively enrolled patients undergoing PCI in 14 Japanese teaching hospitals. We identified patients who experienced ACS or unplanned coronary revascularization following their index PCI and compared subsequent survival during the 2‐year follow‐up period using propensity‐matched cohorts of patients who did and did not experience these events. Cox proportional hazard models were used to assess 2‐year all‐cause mortality. Because unstable angina is less severe than acute myocardial infarction, we also generated a separate propensity‐matched cohort for UA post‐PCI. Among 3348 PCI patients (mean age, 67.5±10.7 years; 79.7% male), 214 (6.4%) experienced a subsequent ACS (168 events [78.5%] were unstable angina), and 198 (5.9%) underwent unplanned revascularization. In the propensity‐matched cohorts, patients with a subsequent ACS admission had an increased risk of mortality as compared with those without (hazard ratio, 4.73; 95% confidence interval=1.35–16.6; P=0.015), whereas those with an unplanned revascularization did not have significantly higher risk (hazard ratio, 2.97; 95% confidence interval=0.57–14.3; P=0.19). Among unstable angina events, no association with mortality was observed (hazard ratio, 1.39; 95% confidence interval=0.48–4.00; P=0.54).ConclusionsIn the KiCS‐PCI registry, the incidence of a subsequent ACS was associated with higher mortality, but this association was less apparent after unplanned coronary revascularization or unstable angina. The prognostic implications of different outcomes in a composite end point should be considered when interpreting the results of clinical trials in PCI.

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Section: Discussionsupporting

confidence: 86%

Prognostic Impact of Subsequent Acute Coronary Syndrome and Unplanned Revascularization on Long‐Term Mortality After an Index Percutaneous Coronary Intervention: A Report From a Japanese Multicenter Registry

Inohara

Kohsaka

Matsubara

et al. 2017

JAHA

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“…The ACC/AHA non–ST‐segment–elevation MI guidelines refer to patients with MI and no obstructive CAD as having Cardiac Syndrome X (CSX),22 while the European Society of Cardiology stable CAD guidelines no longer use the term CSX when describing patients with angina and no obstructive CAD12 because testing now allows the diagnosis of CMD or macrovascular dysfunction12 in a majority of these patients. Previously, the term CSX was used to refer to patients with no obstructive CAD but did not require proof of ischemia23, 24 and also included patients with acute coronary syndromes and no obstructive CAD 22, 23, 25.…”

Section: Inoca—prevalencementioning

confidence: 99%

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

Herscovici

Sedlak

Wei

et al. 2018

JAHA

136

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“…First, TRS2°P seems generally useful to classify 3‐year risk among patients with recent MI in a broad range of clinical settings. Although there are a few validated risk stratification tools (eg, GRACE score and TIMI risk score) for patients with acute coronary syndrome,30, 31 most of these mainly aim to predict short‐term risk (eg, in‐hospital or 14‐day) to make the decision of urgent revascularization 42, 43. Therefore, if the goal is to estimate longer‐term risk over a few years, TRS2°P would be a reasonable option.…”

Section: Discussionmentioning

confidence: 99%

International Validation of the Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention in Post‐MI Patients: A Collaborative Analysis of the Chronic Kidney Disease Prognosis Consortium and the Risk Validation Scientific Committee

Mok

Ballew

Bash

et al. 2018

JAHA

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BackgroundThe Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS2°P), a 0‐to‐9‐point system based on the presence/absence of 9 clinical factors, was developed to classify the risk of major adverse cardiovascular events (MACE) (a composite of cardiovascular death, recurrent myocardial infarction, or ischemic stroke) among patients with a recent myocardial infarction. Its performance has not been examined internationally outside of a clinical trial setting.Methods and ResultsWe evaluated the performance of TRS2°P for predicting MACE in 53 599 patients with recent myocardial infarction in 5 international cohorts from New Zealand, South Korea, Sweden, and the United States participating in the Chronic Kidney Disease Prognosis Consortium. Overall, there were 19 444 cases of MACE across 5 cohorts over a mean follow‐up of 5 years, and the overall MACE rate ranged from 5.0 to 18.4 (per 100 person‐years). The TRS2°P showed modest calibration (Brier score ranged from 0.144 to 0.173) and discrimination (C‐statistics >0.61 in all studies except 1 from Korea with 0.55) across cohorts relative to its original Brier score of 0.098 and C‐statistic of 0.67 in the derived data set. Although there was some heterogeneity across cohorts, the 9 predictors in the TRS2°P were generally associated with higher MACE risk, with strongest associations observed (meta‐analyzed adjusted hazard ratio 1.6–1.7) for history of heart failure, age ≥75 years, and prior stroke, followed by peripheral artery disease, kidney dysfunction, diabetes mellitus, and hypertension (hazard ratio 1.3–1.4). Prior coronary bypass graft surgery and smoking did not reach statistical significance (hazard ratio ≈1.1).ConclusionsTRS2°P, a simple scoring system with 9 routine clinical factors, was modestly predictive of secondary events when applied in patients with recent myocardial infarction from diverse clinical and geographic settings.

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2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes: Executive Summary

Cited by 937 publications

References 351 publications

Prognostic Impact of Subsequent Acute Coronary Syndrome and Unplanned Revascularization on Long‐Term Mortality After an Index Percutaneous Coronary Intervention: A Report From a Japanese Multicenter Registry

Prognostic Impact of Subsequent Acute Coronary Syndrome and Unplanned Revascularization on Long‐Term Mortality After an Index Percutaneous Coronary Intervention: A Report From a Japanese Multicenter Registry

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

International Validation of the Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention in Post‐MI Patients: A Collaborative Analysis of the Chronic Kidney Disease Prognosis Consortium and the Risk Validation Scientific Committee

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