Early revascularization and long-term mortality in high-risk patients with non–ST-elevation myocardial infarction. The CARDIOCHUS-HUSJ registry

• Published in: Revista española de cardiología (English ed.) Vol. 73; no. 1; pp. 35 - 42
• Main Authors: Álvarez Álvarez, Belén, Abou Jokh Casas, Charigan, Cordero, Alberto, Martínez Gómez, Álvaro, Cid Álvarez, Ana Belén, Agra Bermejo, Rosa, García Acuña, José María, Gude Sampedro, Francisco, González Juanatey, José Ramón
• Format: Journal Article
• Language: English; Spanish
• Published: Spain Elsevier España, S.L.U 01.01.2020
• Subjects: All-cause mortality; Alto riesgo; Cardiovascular; Cardiovascular mortality; Cause of Death - trends; Coronariografía precoz; Coronary Angiography; Early coronary intervention; Electrocardiography; Follow-Up Studies; GRACE score; High-risk patients; Humans; Internal Medicine; Mortalidad cardiovascular; Mortalidad total; Non-ST Elevated Myocardial Infarction - diagnosis; Non-ST Elevated Myocardial Infarction - mortality; Non-ST Elevated Myocardial Infarction - surgery; NSTEACS; Percutaneous Coronary Intervention - methods; Prognosis; Propensity Score; Puntuación GRACE; Real world; Registries; Registros de vida real; Retrospective Studies; Risk Factors; SCASEST; Spain - epidemiology; Survival Rate - trends; Time Factors; Spain; All-cause mortality; GRACE score; Registros de vida real; Early coronary intervention; Cardiovascular mortality; High-risk patients; Mortalidad total; SCASEST; NSTEACS; real world; non–ST-segment elevation acute coronary syndrome; Mortalidad cardiovascular; Puntuación GRACE; Alto riesgo; Coronariografía precoz; Real world
• ISSN: 1885-5857; 1885-5857
• DOI: 10.1016/j.rec.2019.02.015

Abstract Introduction and objectives This study sought to analyze the association of early coronary angiography with all-cause mortality and cardiovascular mortality in patients with non–ST-segment elevation acute coronary syndrome (NSTEACS) using a large contemporary cohort of patients with NSTEACS from 2 Spanish tertiary hospitals. Methods This retrospective observational study included 5673 consecutive NSTEACS patients from 2 Spanish hospitals between 2005 and 2016. We performed propensity score matching to obtain a well-balanced subset of patients with the same probability of undergoing an early strategy, resulting in 3780 patients. Survival analyses were performed by Cox regression models once proportional risk test were verified. Results Among the study participants, only 2087 patients (40.9%) underwent early invasive coronary angiography. The median follow-up was 59.0 months [interquartile range, 25.0-80.0 months]. All-cause mortality was 19.0%, cardiovascular mortality was 12.8%, and 51.1% patients experienced at least 1 major cardiovascular adverse event in the follow-up. After propensity score matching, the early strategy was associated with significantly lower mortality (hazard ratio: 0.79; 95% confidence interval 0.62-0.98) in high-risk NSTEACS patients. The darly strategy showed a nonsignificant inverse tendency in patients with GRACE score < 140. Conclusions In high-risk (GRACE score ≥ 140) NSTEACS patients in a contemporary real-world registry, early coronary angiography (first 24 hours after hospital admission) may be associated with reduced all-cause mortality and cardiovascular mortality at long-term follow-up.