The Year in Non–ST-Segment Elevation Acute Coronary Syndrome

Giugliano, Robert P.; Braunwald, Eugene

doi:10.1016/j.jacc.2008.07.005

Cited by 11 publications

(2 citation statements)

References 78 publications

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“…The proportion of non‐ST‐elevation (NSTE) acute coronary syndrome (ACS) relative to ST‐elevation (STE)‐ACS is increasing, probably as a result of demographic changes including an aging population and higher rates of diabetes . According to current practice guidelines, an early invasive strategy is recommended for medium‐ to high‐risk patients with NSTE‐ACS .…”

Section: Introductionmentioning

confidence: 99%

Predictors of high‐risk angiographic findings in patients with non‐ST‐segment elevation acute coronary syndrome

Beigel

Matetzky

Gavrielov-Yusim

et al. 2013

Cathet Cardio Intervent

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Background: Current risk assessment of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) may fail to identify some patients with severe coronary artery disease (CAD). We aimed to identify predictors of the angiographic extent and severity of CAD in patients with NSTE-ACS undergoing early angiography and to evaluate its impact on prognosis. Methods: We evaluated 923 patients with NSTE-ACS who underwent coronary angiography. High-risk coronary anatomy (HRCA) was defined as left main disease > 50%, proximal LAD lesion > 70%, or 2-to 3-vessel disease involving the LAD. Clinical characteristics, in-hospital, and 30-day outcome and 1-year mortality were compared between the high-risk (N 5 370) and the low-risk groups (N 5 553). Results: Proportion of patients with elevated cardiac biomarkers was similar in both groups. The presence of peripheral vascular disease (OR 5 1.88, 95% confidence interval [CI] 5 1.62-5.80, P < 0.001) and a GRACE score of >140 (OR 5 1.88, 95% CI 5 1.29-2.75, P < 0.001) were the strongest predictors of HRCA. Patients with HRCA were prone to more complications during hospitalization and at 30 days (11.9% vs. 6%, P < 0.01) and increased 1-year mortality (6.7% vs. 0.9%, P < 0.001). HRCA was the strongest predictor for 30-day MACCE (OR 5 2.32, 95% CI 5 1.42-3.79, P < 0.001). HRCA (OR 5 8.36, 95% CI 5 1.01-69.4, P 5 0.049; OR 5 3.64, 95% CI 5 1.2-11.07, P 5 0.02) and GRACE score of >140 (OR 5 6.86, 95% CI 5 1.68-27.9, P 5 0.007; OR 5 4.84, 95% CI 5 1.74-13.5, P 5 0.002) were significant predictors of 30-day and 1-year mortality, respectively. Conclusions: HRCA is predicted by clinical parameters and was not associated with elevated cardiac biomarkers. These patients fared worse when compared with those with low-risk anatomy. We suggest that HRCA predictors should be included in the risk stratification of patients with NSTE-ACS. V C 2013 Wiley Periodicals, Inc.

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Section: Introductionmentioning

confidence: 99%

Predictors of high‐risk angiographic findings in patients with non‐ST‐segment elevation acute coronary syndrome

Beigel

Matetzky

Gavrielov-Yusim

et al. 2013

Cathet Cardio Intervent

View full text Add to dashboard Cite

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“…Recent trends in the incidence of acute myocardial infarction show that while rates of ST elevation myocardial infarction (MI) have decreased, those of non‐ST elevation MI (NSTEMI) have increased by nearly 25% over the past decade . While patients with NSTEMI and STEMI share similar cardiac risk factors, their epidemiologic features and clinical presentations are distinct and warrant different management strategies .…”

Section: Introductionmentioning

confidence: 99%

The Presence of angiographic collaterals in Non‐ST elevation myocardial infarction is a predictor of long‐term clinical outcomes

Kloepfer

Lipson

Keeley

2013

Cathet Cardio Intervent

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Objectives To determine whether the presence of angiographic coronary collaterals is a predictor of long-term clinical outcomes in patients with non-ST elevation myocardial infarction (NSTEMI). Background The presence of coronary collaterals on angiography provides prognostic information in patients with STEMI, but it is unknown whether they provide prognostic information in patients with NSTEMI. Methods This was a prospective cohort study of 931 consecutive patients undergoing coronary angiography of which 269 (29%) had a NSTEMI. Baseline characteristics, angiographic details, and long-term clinical outcomes including death, recurrent MI, coronary artery bypass graft surgery (CABG), percutaneous coronary intervention (PCI), stroke, and congestive heart failure (CHF) were collected. Each clinical outcome as well as the combined endpoint of death, recurrent MI, CABG, PCI stroke and CHF was compared in subjects with and without collaterals. Results At one year, individuals with collaterals had significantly increased rates of the combined endpoint compared to those without (25% vs 16%, p=0.0001). On multivariate analysis, the presence of collaterals was a strong predictor of the combined endpoint of death, recurrent MI, CABG, PCI, stroke and CHF (HR 1.95, CI 95% 1.08–3.52; p=0.027). Similarly, in the subset of 115 patients (43%) in whom the culprit artery was identified, the presence of collaterals was a strong negative predictor (HR 3.71, CI 1.31–10.57, p=0.014), driven by a 13-fold increase in subsequent CABG. Conclusions In patients with NSTEMI the presence of angiographic coronary collaterals is a predictor of long-term clinical outcomes primarily driven by increased rates of surgical revascularization.

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Synopsis of Adult Cardiac Surgical Disease

2010

Manual of Perioperative Care in Adult Cardiac Surgery

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The Year in Non–ST-Segment Elevation Acute Coronary Syndrome

Cited by 11 publications

References 78 publications

Predictors of high‐risk angiographic findings in patients with non‐ST‐segment elevation acute coronary syndrome

Predictors of high‐risk angiographic findings in patients with non‐ST‐segment elevation acute coronary syndrome

The Presence of angiographic collaterals in Non‐ST elevation myocardial infarction is a predictor of long‐term clinical outcomes

Synopsis of Adult Cardiac Surgical Disease

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