Association Between Clinical Pathways Leading to Medical Management and Prognosis in Patients With NSTEACS

In-Hospital Coronary Revascularization Rates and Post-Discharge Mortality Risk in Non–ST-Segment Elevation Acute Coronary Syndrome

“…The first is selection bias. It is known that patients undergoing an invasive strategy and receiving coronary revascularization are usually younger, show less comorbidity and are at lower risk than medically managed patients (14,19,20). Although this is true, the comprehensive adjustment of our model and the consistency of the effect found at any level of CRR (i.e., hospital deciles) suggest that the effect cannot fully be explained by differences in baseline characteristics.…”

“…A recent study showed a significant risk-adjusted reduction in 6-month mortality in the UK during the last decade, following a marked increase in the use of coronary angiography and revascularization (4). We, and others, had previously described that NSTE-ACS patients undergoing an invasive strategy and coronary revascularization, either PCI or CABG, showed improved survival compared with medically treated patients (14)(15)(16). A recent analysis of the Atherosclerosis Risk in Communities (ARIC) surveillance study showed that early PCI (under 24 h after symptom onset) in hospitalized NSTEMI patients was associated with improved 28-day survival, especially in high-risk patients, but not at 1 year (17).…”

Conservatively managed patients with non-ST-segment elevation acute coronary syndrome are undertreated with indicated medicines

“…In this study, in patients who did not undergo catheterization, the most commonly used antiplatelet agent was clopidogrel. Thus, it seems that NADs is basically reserved for patients treated with PCI, even though numerous studies have shown comparable benefits across treatment groups [8, 9, 13, 16]. Indeed, in the PLATO study [8], the subgroup of conservatively managed participants (28% of the total) showed lower incidence of the primary outcome (cardiovascular death, myocardial infarction, and stroke) when taking ticagrelor versus clopidogrel (12% vs .…”

“…Thus, this subgroup is the main target for improved clinical management, even if their overall clinical profile makes unlikely that the rates of optimal treatment in this group remain optimal. There is a need for more real-world data emphasizing the potential benefits of DAPT and especially NADs for the prognosis of these patients [16].…”