Invasive strategies and outcomes for non-ST-segment elevation acute coronary syndromes: a twelve-year experience from SWEDEHEART

Abstract

There has been an increase in the use of a routine invasive strategy in NSTE-ACS patients over the course of 12 years in Sweden. There was a decrease in three-year mortality over the same time course.

Treatment strategies and outcomes in patients with non-ST-elevation acute coronary syndrome in the Netherlands

“…The increased use of coronary angiography, decrease in the median time to coronary angiography and increase of patients undergoing early invasive strategy can probably be explained by the ESC guideline recommendations. This observation is in line with a similar report from the Swedish SWEDEHEART registry [ 13 ]. However, contrary to what might be expected based on these recommendations, patients with a higher baseline risk profile as indicated by the GRACE risk score less frequently underwent an early invasive strategy.…”

“…However, contrary to what might be expected based on these recommendations, patients with a higher baseline risk profile as indicated by the GRACE risk score less frequently underwent an early invasive strategy. This inverse relationship between risk profile and the use of invasive treatment, the treatment-risk paradox, has been described previously [ 13 , 14 ]. The explanation for this treatment-paradox is likely multifactorial [ 14 ].…”

Guideline-adherence regarding critical time intervals in the German Chest Pain Unit registry

“…Our data suggest that the current rate of primary PCI among patients with NSTE-ACS (58.4%) is higher than in the Swedish SWEDEHEART registry in the period 2005-2007 (37.4%) and comparable to the rate in the second Euro Heart Survey on ACS (63%), which included 190 medical centres in Europe and the Mediterranean basin in 2004. 20,21 In patients with NSTEMI, PCI was performed during the first 24 h in 79.5%. One explanation of why not even more patients were treated with PCI in this time interval may be that in some patients with type 2 myocardial infarction with an imbalance of oxygen demand and supply due to a non-coronary cause such as prolonged tachycardia or in the setting of severe acute heart failure, treatment strategies have to be individualized.…”

Inversed relationship between completeness of follow-up and coverage of postoperative complications in gallstone surgery and ERCP: a potential source of bias in patient registers

“…Databases with long-term follow-up open up for conduct of studies focusing on rare events harms and effects occurring late in the clinical course. There are several instances where registry-based studies have improved the management of patients, for example, in the treatment of non-ST-segment elevation acute coronary syndrome, 1 the elimination of substandard orthopaedic prostheses from clinical use 2 and the effects of different surgical approaches and suture materials on the outcome of hernia surgery. 3 4 Accordingly registry studies can address clinical questions that due to statistical power issues, time and financial constraints would never have been studied under the design of a RCT such as the value of intraoperative cholangiography in preventing bile duct injury in association with gallstone surgery 5 6 with data from the Swedish Registry for Gallstone Surgery and ERCP (GallRiks) or the question whether and why women with inguinal herniorrhaphies have a significantly higher reoperation rate compared with men (data from the Swedish Hernia Registry).…”