Routine vs Selective Invasive Strategies in Patients With Acute Coronary Syndromes

Mehta, Shamir R.; Cannon, Christopher P.; Fox, Keith A.A.; Wallentin, Lars; Boden, William E.; Spacek, R; Widimský, Petr; McCullough, Peter A.; Hunt, David; Braunwald, Eugene; Yusuf, Salim

doi:10.1001/jama.293.23.2908

Cited by 732 publications

(265 citation statements)

References 41 publications

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“…In addition, group A patients had a higher risk profile and had more elevated levels of cardiac biomarkers. Two large meta-analyses including large RCTs comparing early invasive versus conservative strategies for NSTE-ACS revealed that higher-risk patients with elevated cardiac biomarker levels at baseline benefited more from routine invasive intervention, 19 with a reduction in the combined end point of MI and death seen only in patients with high-risk features, including those with elevated troponin levels. 20 Furthermore, the occurrence of postoperative MI was extremely low in the present study, occurring most in patients operated after 72 hours of NSTEMI.…”

Section: Discussionmentioning

confidence: 99%

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%

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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“…Many randomized, controlled trials 5,6 exclude elderly patients with specified comorbid conditions, which limits the generalizability of the results to patients in routine practice. 4,[7][8][9][10][11][12] There is a particular lack of data concerning the long-term adverse outcomes for these patients.…”

Section: Clinical Perspective On P 2404mentioning

confidence: 99%

Frailty Is Independently Associated With Short-Term Outcomes for Elderly Patients With Non–ST-Segment Elevation Myocardial Infarction

Ekerstad

Swahn²,

Janzon³

et al. 2011

Circulation

296

202

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Background-For the large and growing population of elderly patients with cardiovascular disease, it is important to identify clinically relevant measures of biological age and their contribution to risk. Frailty is an emerging concept in medicine denoting increased vulnerability and decreased physiological reserves. We analyzed the manner in which the variable frailty predicts short-term outcomes for elderly non-ST-segment elevation myocardial infarction patients. Methods and Results-Patients aged Ն75 years, with diagnosed non-ST-segment elevation myocardial infarction were included at 3 centers, and clinical data including judgment of frailty were collected prospectively. Frailty was defined according to the Canadian Study of Health and Aging Clinical Frailty Scale. The impact of the comorbid conditions on risk was quantified by the coronary artery disease-specific index. Of 307 patients, 149 (48.5%) were considered frail. By multiple logistic regression, frailty was found to be strongly and independently associated with risk for the primary composite outcome (death from any cause, myocardial reinfarction, revascularization due to ischemia, hospitalization for any cause, major bleeding, stroke/transient ischemic attack, and need for dialysis up to 1 month after inclusion) (odds ratio, 2.2; 95% confidence interval, 1.3-3.7), in-hospital mortality (odds ratio, 4.6; 95% confidence interval, 1.3-16.8), and 1-month mortality (odds ratio, 4.7; 95% confidence interval, 1.7-13.0). Conclusions-Frailty is strongly and independently associated with in-hospital mortality, 1-month mortality, prolonged hospital care, and the primary composite outcome. The combined use of frailty and comorbidity may constitute an ultimate risk prediction concept in regard to cardiovascular patients with complex needs. Clinical Trial Registration-http://www.clinicaltrials.gov.

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“…In both cases female participants showed a deeper depressive symptomatology and experienced deeper burden. Other studies (Frias, Tuokko & Rosenberg, 2005;Mehta, 2005) also…”

Section: Discussion/conclusionmentioning

confidence: 91%

Caregivers’ burden experienced by relatives living with a person suffering from schizophrenia

Cabral¹,

Almeida²,

Ferreira³

et al. 2016

European Proceedings of Social &Amp; Behavioural Sciences

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Schizophrenia is a complex chronic disease that turns the affected person into a dependent and disorganized patient. This pathology is responsible for a major burden on the family members who are in charge of taking care of that person. Analyze to what extant can socio-demographic, clinical and environmental variables interfere with the burden felt by family members who live with someone suffering from schizophrenia; to analyze the relationship between a depressive mood state and the burden on the family members who live with a person suffering from schizophrenia were our objectives. As a methodology, quantitative and non-experimental, cross-sectional, descriptive and correlational study. The data collection was done through socio-demographic questionnaires; Vaz Serra and Pio Abreu's Portuguese version of Beck Depression Inventory (1973); Zarit Burden Interview adapted by Sequeira (2007). 95 informal caregivers taking care of schizophrenic patients were assessed. Participants are mainly female (66%), aged 40 or over (79%) and 36 % are the patients' mothers. Gender, age and existing family ties variables interfered significantly with the impact caused on the caregiver's burden. There was a statistically significant correlation between the depressive symptomatology and the burden experienced by the family caregivers. Family/ informal caregiver experience several difficulties when they have to go through a daily process of taking care of a family member suffering from schizophrenia. This situation may cause exhaustion, conflicts, emotional suffering and even depressive symptomatology. This burden of care grows stronger as the patients are older, when they are male and when there are no families ties binding patient and caregiver. These variables must be taken into account in these caregivers' service plans.

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Routine vs Selective Invasive Strategies in Patients With Acute Coronary Syndromes

Cited by 732 publications

References 41 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?

Frailty Is Independently Associated With Short-Term Outcomes for Elderly Patients With Non–ST-Segment Elevation Myocardial Infarction

Caregivers’ burden experienced by relatives living with a person suffering from schizophrenia

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