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

Abstract

Introduction and aimsPatients with non-ST-elevation acute coronary syndrome (NSTE-ACS) are often managed conservatively. Clinical practice guidelines recommend treating these patients with the same pharmacological drugs as those who receive invasive treatment. We analyze the use of new antiplatelet drugs (NADs) and other recommended treatments in people discharged following an NSTE-ACS according to the treatment strategy used, comparing the medium-term prognosis between groups.MethodsProspective observational multicenter registry study in 1717 patients discharged from hospital following an ACS; 1143 patients had experienced an NSTE-ACS. We analyzed groups receiving the following treatment: No cardiac catheterization (NO CATH): n = 134; 11.7%; Cardiac catheterization without revascularization (CATH-NO REVASC): n = 256; 22.4%; percutaneous coronary intervention (PCI): n = 629; 55.0%; and coronary artery bypass graft (CABG): n = 124; 10.8%. We assessed major adverse cardiovascular events (MACE), all-cause mortality, and hemorrhagic complications at one year.ResultsNO CATH was the oldest, had the most comorbidities, and was at the highest risk for ischemic and hemorrhagic events. Few patients who were not revascularized with PCI received NADs (NO CATH: 3.7%; CATH-NO REVASC: 10.6%; PCI: 43.2%; CABG: 3.2%; p<0.001). Non-revascularized patients also received fewer beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB), and statins (p<0.001). At one year, MACE incidence in NO CATH group was three times that of the other groups (30.1%, p<0.001), and all-cause mortality was also much higher (26.3%, p<0.001). There were no significant differences in hemorrhagic events. Belonging to NO CATH group was an independent predictor for MACE at one year in the multivariate analysis (HR 2.72, 95% CI 1.29–5.73; p = 0.008).ConclusionsDespite current invasive management of NSTE-ACS, patients not receiving catheterization are at very high risk for under treatment with recommended drugs, including NADs. Their medium-term prognosis is poor, with high mortality. Patients treated with PCI receive better pharmacological management, with high use of NADs.

Frequência e Motivos para a não Administração e Suspensão de Medicamentos durante um Evento de Síndrome Coronariana Aguda. Estudo ERICO

“…A frequência da não administração ou suspensão do medicamento durante o tratamento de um evento de SCA foi reportada em outros cenários. Candela et al 19 analisaram dados de 1.134 pacientes com SCA sem supradesnivelamento de ST tratados em hospitais terciários na Espanha. Esses autores analisaram grupos de acordo com as opções de tratamento por ACTP e/ou CABG, e identificaram que, nas primeiras 24 horas, de 96,3% a 99,2% receberam aspirina, de 75,8% a 83,6% receberam heparina, e de 67,7% a 77,9% receberam clopidogrel (essa proporção pode subir para estar entre 78,3% e 99,2% entre os grupos, quando a proporção dos indivíduos que receberam prasugrel e/ou ticagrelor é acrescentada) Khedri et al, 20 analisaram uma amostra grande de 75.129 pacientes com SCA na Suécia usando um sistema nacional online.…”