Temporal trends between association of evidence-based treatment and outcomes in patients with non-ST-elevation myocardial infarction

Álvarez‐Álvarez, Belén; Casas, C.; Acuña, José María García; Álvarez, Belén Cid; Bermejo, Rosa María Agra; Cordero, Alberto; Rodríguez‐Mañero, Moisés; Sampedro, Francisco Gude; González-Juanatey, José Ramón

doi:10.1016/j.ijcard.2018.02.110

Cited by 12 publications

(5 citation statements)

References 24 publications

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“…Also, we do not have data about the repeat revascularization during the follow-up. Finally, longterm outcomes could be modified by many circumstances that might not be available with the follow-up protocol of our center [36]. Nonetheless, since clinical features and event rates were similar to previous reports [37,38], we believe that these limitations might not have had a major influence on the validity of our results.…”

Section: Discussionmentioning

confidence: 64%

Long term prognostic benefit of complete revascularization in elderly presenting with NSTEMI: real world evidence

Agra-Bermejo¹,

Cordero²,

Veloso³

et al. 2021

Reviews in Cardiovascular Medicine

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The benefit of complete revascularization in elderly patients with non-ST elevation myocardial infarction (NSTEMI), and multivessel disease remains debated (MVD). The aim of our study was to determine the current long-term prognostic benefit of complete revascularization in this population. A retrospective cohort study of 1722 consecutive elderly NSTEMI patients was performed. Among the study participants 30.4% (n = 524) were completed revascularizated and in 69.6% (n = 1198) culprit vessel only revascularization was performed. A propensity score analysis was performed and we divided the study population into two groups: complete revascularization (n = 500) and culprit vessel only revascularization (n = 500). The median followup was 45.7 months, the all cause mortality (44.5% vs 30.5%, p < 0.001) (HR 0.74 (0.57-0.97); p = 0.035) and cardiovascular mortality (32.6% vs 17.4%, p < 0.001) (HR = 0.67 (0.47-0.94); p = 0.021) were significantly lower in patients with complete revascularization. In our study, we observed a long-term benefit of complete revascularization in elderly NSTEMI and MVD patients. Elderly patients should also be managed according to current guidelines to improve their long-term prognosis.

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Section: Discussionmentioning

confidence: 64%

Long term prognostic benefit of complete revascularization in elderly presenting with NSTEMI: real world evidence

Agra-Bermejo¹,

Cordero²,

Veloso³

et al. 2021

Reviews in Cardiovascular Medicine

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“…Current NSTEMI guidelines clearly state that interventional procedures for revascularization should be applied at any age [ 13 ]. Nonetheless, age is frequently reported as the variable most closely related to lower revascularization rates [ 27 ]. Of all the reasons postulated for the underuse of revascularization, the leading limitations might be the excess of bleeding complications or the lack of long-term benefit [ 28 ].…”

Section: Non-stemi (Nstemi) Patients: Invasive Versus Conservative Treatment?mentioning

confidence: 99%

Acute Coronary Syndrome in the Older Patient

García‐Blas

Cordero

Díez‐Villanueva

et al. 2021

JCM

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Coronary artery disease is one of the leading causes of morbidity and mortality, and its prevalence increases with age. The growing number of older patients and their differential characteristics make its management a challenge in clinical practice. The aim of this review is to summarize the state-of-the-art in diagnosis and treatment of acute coronary syndromes in this subgroup of patients. This comprises peculiarities of ST-segment elevation myocardial infarction (STEMI) management, updated evidence of non-STEMI therapeutic strategies, individualization of antiplatelet treatment (weighting ischemic and hemorrhagic risks), as well as assessment of geriatric conditions and ethical issues in decision making.

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“…Primary percutaneous intervention (pPCI) has radically changed the prognosis of STEMI. 5,7 Clinical registries have outlined that STEMI patients are usually younger and have less extensive coronary disease. [8][9][10] Current evidence supports both safety of early discharge (after 48 h of care) and omission of ICU admission in carefully selected patients following pPCI.…”

Section: Introductionmentioning

confidence: 99%

Applicability of the Zwolle score for selection of very high-risk ST-elevation myocardial infarction patients treated with primary angioplasty

et al. 2022

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The Zwolle risk score was designed to stratify in-hospital mortality risk of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (pPCI) and for decision-making in the unit where patients are admitted. We assessed the accuracy of Zwolle risk score for in-hospital mortality estimation compared with the GRACE score in all patients (n = 4446) admitted for STEMI in 3 university hospitals. Only one fourth of the patients were classified as high-risk by the Zwolle risk score vs 60% by the GRACE score. In-hospital mortality was 10.6%. A statistically significant increase in in-hospital mortality, adjusted by age, gender, and revascularization, was observed with both scores. The assessment of the optimal cut-off points verified the accuracy of Zwolle score ≥4 as optimal threshold for high-risk categorization. In contrast, GRACE score ≥140 had very low specificity as well as percentage of patients correctly classified; GRACE score ≥175 was fairly better. The reclassification index of the Zwolle score after applying the GRACE score was 35.5%. Selection of high-risk STEMI patients treated with pPCI based on the Zwolle risk score has higher specificity than the GRACE score and might be useful in clinical practice.

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Temporal trends between association of evidence-based treatment and outcomes in patients with non-ST-elevation myocardial infarction

Cited by 12 publications

References 24 publications

Long term prognostic benefit of complete revascularization in elderly presenting with NSTEMI: real world evidence

Long term prognostic benefit of complete revascularization in elderly presenting with NSTEMI: real world evidence

Acute Coronary Syndrome in the Older Patient

Applicability of the Zwolle score for selection of very high-risk ST-elevation myocardial infarction patients treated with primary angioplasty

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