Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology

Bassand, Jean‐Pierre; Hamm, C; Ardissino, Diego; Boersma, Eric; Budaj, Andrzej; Fernández‐Avilés, Francisco; Fox, Keith; Hasdai, David; Ohman, E. Magnus; Wallentin, Lars; Wijns, William; Vahanian, Alec; Camm, John; Dean, Veronica; Dickstein, Kenneth; Filippatos, Gerasimos; Widimský, Petr; McGregor, Keith; Sechtem, Udo; Tendera, Michał; Hellemans, Irene; Gómez, José Luis Zamorano; Funck‐Brentano, Christian; Kristensen, Steen Dalby; Andreotti, Felicita; Benzer, Werner; Bertrand, M; Betriu, Amadeo; Caterina, Raffaele De; Desutter, J; Falk, Volkmar; Ortiz, Antonio Fernández; Gitt, Anselm K.; Hasin, Yonathan; Huber, Kurt; Kornowski, Ran; López‐Sendón, José; Morais, João; Nordrehaug, Jan Erik; Silber, Sigmund; Steg, P. Gabriel; Thygesen, Kristian; Tubaro, Marco; Turpie, A. G. G.; Verheugt, Freek W.A.; Windecker, S.

doi:10.1093/eurheartj/ehm161

Cited by 1,440 publications

(213 citation statements)

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“…Our findings are also reflected by a meta-analysis of 3 large RCTs comparing routine and selective invasive strategy in patients with NSTEMI, which showed 2.0% to 3.8% absolute reductions in cardiovascular death or MI in the low-and intermediate-risk groups and an 11.1% absolute risk reduction in highest-risk patients. 22 One of the major concerns surgeons have in performing emergent CABG after acute MI is the increased risk of bleeding resulting from the liberal use of "upstream" antiplatelet medications, which should be initiated as soon as possible after the diagnosis of ACS is made 10 to avoid ischemic complications. Our study also found that administration of P2Y 12 inhibitors in addition to aspirin in patients with NSTEMI until surgery is protective against HM (odds ratio, 0.3; 95% CI, 0.1-0.8; P=0.01; Table 4).…”

Section: Discussionmentioning

confidence: 99%

“…Two treatment strategies that have emerged for patients with NSTEMI with respect to invasive diagnosis and intervention are early invasive (within 24 hours) and delayed invasive (25-72 hours). 10 We therefore created 3 groups based on the time interval between symptom onset and start of surgery. Patients were operated on within 24 hours after symptom onset (group A), between 24 to 72 hours after symptom onset (group B), and after 72 hours after symptom onset (group C).…”

Section: Patient Groupsmentioning

confidence: 99%

“…10 The main objective of our study was to determine the effect of the time interval between the onset of NSTEMI and CABG on in-hospital and long-term outcomes and thus to identify the most favorable time period in which to perform the operation.…”

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confidence: 99%

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Does Timing of Coronary Artery Bypass Surgery Affect Early and Long-Term Outcomes in Patients With Non–ST-Segment–Elevation Myocardial Infarction?

et al. 2015

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Background-Current guidelines do not provide recommendations for optimal timing of coronary artery bypass surgery (CABG) in patients with non-ST-segment-elevation myocardial infarction. Our study aimed to determine the impact of CABG timing on early and late outcomes in patients with non-ST-segment-elevation myocardial infarction. Methods and Results-A total of 758 patients underwent CABG within 21 days after non-ST-segment-elevation myocardial infarction between January 2008 and December 2012 at our institution. The patients were divided into 3 groups according to the time interval between symptom onset and CABG: group A, <24 hours (133 patients); group B, 24 to 72 hours (192 patients); and group C, >72 hours to 21 days (433 patients). Predictors of in-hospital and long-term mortality were identified by logistic and Cox regression analyses, respectively. Overall in-hospital mortality was 5.1% (39 patients): 6.0%, 4.7%, and 5.1% in groups A, B, and C (P=0.9), respectively. A total of 118 patients died during follow-up. The 5-year survival was 73.1±2%, with a nonsignificant trend toward better survival in groups A (78.2±4%) and C (75.4±3%) compared with group B (63.6±5%; log-rank P=0.06). Renal insufficiency and LMD were independent predictors of in-hospital (odds ratio, 3.1; P=0.001; and odds ratio, 3.1; P=0.002) and long-term mortality (hazard ratio, 1.7; P=0.004; and hazard ratio, 1.5; P=0.02), whereas administration of P2Y 12 inhibitors was protective (odds ratio, 0.3; P=0.01). Conclusions-Emergent CABG within 24 hours of non-ST-segment-elevation myocardial infarction is associated with in-hospital mortality and long-term outcomes similar to those of CABG performed after 3 days, despite a higher risk profile. CABG performed between 24 to 72 hours showed a nonsignificant trend toward poorer long-term outcomes. Dual antiplatelet therapy until surgery is beneficial, whereas renal insufficiency and left main disease increase the risk of early and late death. (Circulation. 2015;132:731-740.

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Section: Discussionmentioning

confidence: 99%

Section: Patient Groupsmentioning

confidence: 99%

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Does Timing of Coronary Artery Bypass Surgery Affect Early and Long-Term Outcomes in Patients With Non–ST-Segment–Elevation Myocardial Infarction?

et al. 2015

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“…The periods were ≤2002, 2003–2007 and 2008–2010. These periods were categorized based on the year when the ESC guidelines for MI 5, 12, 13, 14 were published. Adherence to antiplatelet drugs was reported as the average percentage, and the mean differences were analysed using the independent t ‐test.…”

Section: Methodsmentioning

confidence: 99%

Patterns of antiplatelet drug use after a first myocardial infarction during a 10‐year period

Yasmina

Boer

Deneer

et al. 2016

Brit J Clinical Pharma

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AimsThe aims of the present study were to assess antiplatelet drug use patterns after a first myocardial infarction (MI) and to evaluate the determinants of antiplatelet nonpersistence.MethodsThe present study was conducted in 4690 patients from the Utrecht Cardiovascular Pharmacogenetics cohort with a first MI between 1986 and 2010, who were followed for a maximum of 10 years. Medication use and event diagnosis were obtained from the Dutch PHARMO Record Linkage System. Antiplatelet drug users were classified as persistent users (gap between prescriptions ≤90 days), nonpersistent users (>90‐day gap and no refills), and restarters (a new prescription after a >90‐day gap). The association between potential determinants and antiplatelet nonpersistence was analysed using Cox regression.ResultsThe proportions of persistent users decreased from 84.0% at the 1‐year follow‐up to 32.8% at 10 years for any antiplatelet drug, and 77.3% to 27.5% for aspirin; and 39.0% to 6.4% for clopidogrel at 6 years. Most nonpersistent users restarted antiplatelet drugs later, leading to 89.3% overall antiplatelet drug users at 10 years after MI. Diabetes (hazard ratio [HR] 0.44; 0.32–0.60), hypertension (HR 0.77; 0.60–0.99), hypercholesterolaemia (HR 0.49; 0.39–0.62) and more recent MI diagnosis period (2003–2007: HR 0.69, 0.61–0.79; 2008–2010: HR 0.38, 0.19–0.77, compared to ≤ 2002 period) lowered the risk of antiplatelet nonpersistence, while vitamin K antagonist (VKA) comedication (HR 18.97; 16.91–21.28) increased this risk.ConclusionsA large proportion of patients with a first MI still used antiplatelet drugs after 10 years. The frequent discontinuations during this time frame are expected to reduce the effectiveness of antiplatelet drugs as secondary prevention of cardiovascular diseases. Diabetes, hypertension, hypercholesterolaemia, VKA comedication and MI diagnosis period were determinants of antiplatelet nonpersistence.

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“…However, enrollment in the SOLID‐ TIMI 52 trial occurred between 2009 and 2011, so neither factor would have affected statin use in the current study. Although some guidelines that were available at the time of the trial recommended the routine use of high‐potency statins in patients after ACS,7, 17, 18 other guidelines focused primarily on achieving LDL cholesterol concentrations <100 or <70 mg/dL in high‐risk patients 19, 20. We observed, however, that the use of high‐potency statins was also low in patients who had not achieved desired LDL cholesterol target goals.…”

Section: Discussionmentioning

confidence: 75%

Predictors of Nonuse of a High‐Potency Statin After an Acute Coronary Syndrome: Insights From the Stabilization of Plaques Using Darapladib‐Thrombolysis in Myocardial Infarction 52 (SOLID‐TIMI 52) Trial

Eisen

Cannon

Braunwald

et al. 2017

JAHA

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BackgroundHigh‐potency statins reduce cardiovascular events after acute coronary syndromes but remain underused in clinical practice. We examined predictors of nonuse of high‐potency statins after acute coronary syndromes.Methods and ResultsThe Stabilization of pLaques usIng Darapladib‐Thrombolysis in Myocardial Infarction (SOLID‐TIMI 52) trial enrolled patients after an acute coronary syndrome in 36 countries between 2009 and 2011. Statin use was strongly encouraged throughout the trial, and statin potency was at the discretion of the treating physician. A high‐potency statin was defined as ≥40 mg atorvastatin, ≥20 mg rosuvastatin, or 80 mg simvastatin daily. Predictors of nonuse of high‐potency statins were examined using logistic regression. Of the patients included (n=12 446), 11 850 (95.2%) were treated with a statin at baseline after acute coronary syndrome (median 14 days), but only 5212 (41.9%) were on a high‐potency statin. Selected patient factors associated with nonuse of high‐potency statins included age ≥75 years (odds ratio 1.39, 95% CI 1.24–1.56), female sex (odds ratio 1.11, 95% CI 1.02–1.22), renal dysfunction (odds ratio 1.17, 95% CI 1.03–1.32), and heart failure during hospital admission (odds ratio 1.43, 95% CI 1.27–1.62). At 3 months after baseline, only 49% of patients had low‐density lipoprotein cholesterol <70 mg/dL. Among the 5490 patients (59%) who were not on a high‐potency statin at 3 months, lower low‐density lipoprotein cholesterol was a predictor of nonuse of a high‐potency statin after a median of 2.3 years (odds ratio 1.15 for 10 mg/dL decrease, 95% CI 1.11–1.19).ConclusionDespite the widespread use of statins after acute coronary syndromes, most patients are not treated with high‐potency statins early and late after the event, including patients at the highest risk of recurrent cardiovascular events.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01000727.

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Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology

Cited by 1,440 publications

References 501 publications

Does Timing of Coronary Artery Bypass Surgery Affect Early and Long-Term Outcomes in Patients With Non–ST-Segment–Elevation Myocardial Infarction?

Does Timing of Coronary Artery Bypass Surgery Affect Early and Long-Term Outcomes in Patients With Non–ST-Segment–Elevation Myocardial Infarction?

Patterns of antiplatelet drug use after a first myocardial infarction during a 10‐year period

Predictors of Nonuse of a High‐Potency Statin After an Acute Coronary Syndrome: Insights From the Stabilization of Plaques Using Darapladib‐Thrombolysis in Myocardial Infarction 52 (SOLID‐TIMI 52) Trial

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