PMID- 33687519 OWN - NLM STAT- MEDLINE DCOM- 20220112 LR - 20220112 IS - 1861-0692 (Electronic) IS - 1861-0684 (Linking) VI - 110 IP - 9 DP - 2021 Sep TI - Prognostic benefit from an early invasive strategy in patients with non-ST elevation acute coronary syndrome (NSTEACS): evaluation of the new risk stratification in the NSTEACS European guidelines. PG - 1464-1472 LID - 10.1007/s00392-021-01829-8 [doi] AB - OBJECTIVES: The objective of our work is to evaluate the prognostic benefit of an early invasive strategy in patients with high-risk NSTACS according to the recommendations of the 2020 clinical practice guidelines during long-term follow-up. METHODS: This retrospective observational study included 6454 consecutive NSTEACS patients. We analyze the effects of early coronary angiography (< 24 h) in patients with: (a) GRACE risk score > 140 and (b) patients with "established NSTEMI" (non ST-segment elevation myocardial infarction defined by an increase in troponins) or dynamic ST-T-segment changes with a GRACE risk score < 140. RESULTS: From 2003 to 2017, 6454 patients with "new high-risk NSTEACS" were admitted, and 6031 (93.45%) of these underwent coronary angiography. After inverse probability of treatment weighting, the long-term cumulative probability of being free of all-cause mortality, cardiovascular mortality and MACE differed significantly due to an early coronary intervention in patients with NSTEACS and GRACE > 140 [HR 0.62 (IC 95% 0.57-0.67), HR 0.62 (IC 95% 0.56-0.68), HR 0.57 (IC 95% 0.53-0.61), respectively]. In patients with NSTEACS and GRACE < 140 with established NSTEMI or ST/T-segment changes, the benefit of the early invasive strategy is only observed in the reduction of MACE [HR 0.62 (IC 95% 0.56-0.68)], but not for total mortality [HR 0.96 (IC 95% 0.78-1.2)] and cardiovascular mortality [HR 0.96 (IC 95% 0.75-1.24)]. CONCLUSIONS: An early invasive management is associated with reduced all-cause mortality, cardiovascular mortality and MACE in NSTEACS with high GRACE risk score. However, this benefit is less evident in the subgroup of patients with a GRACE score < 140 with established NSTEMI or ST/T-segment changes. CI - (c) 2021. Springer-Verlag GmbH Germany, part of Springer Nature. FAU - Martinon-Martinez, Jesus AU - Martinon-Martinez J AD - Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rua da Choupana s/n. 15703, Santiago de Compostela, Spain. jmartinonmartinez@gmail.com. FAU - Alvarez Alvarez, Belen AU - Alvarez Alvarez B AD - Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rua da Choupana s/n. 15703, Santiago de Compostela, Spain. AD - Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain. FAU - Gonzalez Ferrero, Teba AU - Gonzalez Ferrero T AD - Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rua da Choupana s/n. 15703, Santiago de Compostela, Spain. AD - Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain. FAU - Garcia-Rodeja Arias, Federico AU - Garcia-Rodeja Arias F AD - Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rua da Choupana s/n. 15703, Santiago de Compostela, Spain. FAU - Otero Garcia, Oscar AU - Otero Garcia O AD - Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rua da Choupana s/n. 15703, Santiago de Compostela, Spain. AD - Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain. FAU - Cacho Antonio, Carla AU - Cacho Antonio C AD - Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rua da Choupana s/n. 15703, Santiago de Compostela, Spain. AD - Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain. FAU - Abou Jokh Casas, Charigan AU - Abou Jokh Casas C AD - Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rua da Choupana s/n. 15703, Santiago de Compostela, Spain. AD - Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain. FAU - Zuazola, Pilar AU - Zuazola P AD - Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain. AD - Cardiology Department, University Hospital of San Juan, Alicante, Spain. FAU - Cordero, Alberto AU - Cordero A AD - Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain. AD - Cardiology Department, University Hospital of San Juan, Alicante, Spain. FAU - Escribano, David AU - Escribano D AD - Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain. AD - Cardiology Department, University Hospital of San Juan, Alicante, Spain. FAU - Cid Alvarez, Belen AU - Cid Alvarez B AD - Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rua da Choupana s/n. 15703, Santiago de Compostela, Spain. AD - Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain. FAU - Iglesias Alvarez, Diego AU - Iglesias Alvarez D AD - Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rua da Choupana s/n. 15703, Santiago de Compostela, Spain. AD - Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain. FAU - Agra Bermejo, Rosa AU - Agra Bermejo R AD - Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rua da Choupana s/n. 15703, Santiago de Compostela, Spain. AD - Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain. FAU - Rigueiro Veloso, Pedro AU - Rigueiro Veloso P AD - Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rua da Choupana s/n. 15703, Santiago de Compostela, Spain. AD - Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain. FAU - Garcia Acuna, Jose Maria AU - Garcia Acuna JM AD - Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rua da Choupana s/n. 15703, Santiago de Compostela, Spain. AD - Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain. FAU - Gude Sampedro, Francisco AU - Gude Sampedro F AD - Epidemiology Department, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain. FAU - Gonzalez Juanatey, Jose Ramon AU - Gonzalez Juanatey JR AD - Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rua da Choupana s/n. 15703, Santiago de Compostela, Spain. AD - Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain. LA - eng PT - Journal Article PT - Observational Study DEP - 20210309 PL - Germany TA - Clin Res Cardiol JT - Clinical research in cardiology : official journal of the German Cardiac Society JID - 101264123 SB - IM MH - Acute Coronary Syndrome/*diagnostic imaging/mortality/therapy MH - Aged MH - Aged, 80 and over MH - Coronary Angiography/*methods MH - Europe MH - Female MH - Follow-Up Studies MH - Humans MH - Male MH - Middle Aged MH - Non-ST Elevated Myocardial Infarction/*diagnostic imaging/mortality/therapy MH - *Practice Guidelines as Topic MH - Prognosis MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Time Factors OTO - NOTNLM OT - Early coronary intervention OT - GRACE OT - Guidelines OT - Long-term outcomes OT - NSTEACS OT - NSTEMI EDAT- 2021/03/10 06:00 MHDA- 2022/01/13 06:00 CRDT- 2021/03/09 12:12 PHST- 2020/12/22 00:00 [received] PHST- 2021/02/24 00:00 [accepted] PHST- 2021/03/10 06:00 [pubmed] PHST- 2022/01/13 06:00 [medline] PHST- 2021/03/09 12:12 [entrez] AID - 10.1007/s00392-021-01829-8 [pii] AID - 10.1007/s00392-021-01829-8 [doi] PST - ppublish SO - Clin Res Cardiol. 2021 Sep;110(9):1464-1472. doi: 10.1007/s00392-021-01829-8. Epub 2021 Mar 9.