Outcomes in Patients with Acute Non-Q-Wave Myocardial Infarction Randomly Assigned to an Invasive as Compared with a Conservative Management Strategy

Risk Stratification in Non‐ST Segment Elevation Acute Coronary Syndromes with Special Focus on Recent Guidelines

“…Retrospectively identified predictors of a superior outcome of either a conservative or aggressive treatment strategy, derived from studies comparing an aggressive and conservative approach to management of unstable angina and non-ST segment elevation myocardial infarction, are shown in Table 8. [144][145][146][147][148][149][150][151][152] In addition to the TACTICS-TIMI 18 data presented, separate abstracts recently were published that confirm the benefit of troponin I in addition to troponin T, 153 address the utility of the TIMI risk score, 33,154 and identify CRP 155 as markers to predict 6month mortality benefits of an invasive approach. Troponin I was also associated with an increased need for urgent revascularization within 14 days in patients managed conservatively in the TIMI 11B trial, 35 indicating a potential value for early procedures in those patients.…”

“…This has important implications because patients with a strongly positive risk-stratifying procedure will undergo angiography and subsequent revascularization. Another risk stratification score 159 was developed from the Veterans Affairs Non-Q-Wave Infarction Strategies In-hospital (VANQWISH) trial, 145 which originally reported a significant increase in mortality with an aggressive approach up to 1 year after randomization. The risk score, 152 composed of prior myocardial infarction, diabetes mellitus, peripheral vascular disease, hypertension, ST segment depression, anterior myocardial infarction, nonsinus rhythm on admission, and QRS interval duration on the ECG, and scored from 0-8, predicted a benefit of aggressive management in patients with scores of 5 or greater, and a benefit of conservative management in patients with a risk score of 2 or less.…”

Evaluation of serial QT dispersion in patients with first non‐Q‐wave myocardial infarction: Relation to the severity of underlying coronary artery disease

“…30 This has led many cardiologists to perform routinely delayed coronary angiography and then revascularization, even though recent reports support a conservative ischemia-guided approach. 18 The results of our study offer an insight into the factors affecting QTD in patients with non-Qwave MI. In addition, the observation that QTD parameters correlate with the severity of underlying CAD and, furthermore, that these parameters significantly shorten only in the group with less severe CAD, could illustrate QTD as a simple, feasible, and inexpensive method for recognizing patients at higher risk, so that either alone, or in combination with other noninvasive markers, 18,24,28 could contribute to better risk stratification and management of patients with non-Q-wave MI.…”

“…This population is clearly different in terms of in-hospital course and further prognosis compared with Q-wave patients with MI. 17,18,30 In our study, besides QTD assessment, a number of established clinical and noninvasive laboratory variables were also analyzed in an attempt to evaluate their contribution to the determination of QTD in this group of patients. The severity of underlying CAD was estimated by the number of diseased vessels as well as by assessment of JS.…”

Timing of Early Invasive Intervention in Patients with Moderate to High Risk Acute Coronary Syndromes

“…Some early invasive trials in ACS failed to show any benefit of revascular-ization, while others actually found that it was harmful, especially in the early nonstent era. [1][2][3] However, with improvements in percutaneous coronary intervention (PCI) and the advent of novel adjunctive pharmacotherapy agents (such as GP 2b/3a inhibitors, new antiplatelet agents, and intensive statin regimens), the safety and efficacy of early PCI in ACS has improved significantly. Therefore, an early invasive intervention is now widely recommended among patients at high risk for ACS in both the American Heart Association and European Society of Cardiology (ESC) guidelines.…”