Department of Cardiology, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario de Alicante, Alicante, Spain.
Department of Cardiology, IMIB-Arrixaca CIBER-CV, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
PLoS One. 2018 Nov 28;13(11):e0208069. doi: 10.1371/journal.pone.0208069. eCollection 2018.
Patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) are often managed conservatively. Clinical practice guidelines recommend treating these patients with the same pharmacological drugs as those who receive invasive treatment. We analyze the use of new antiplatelet drugs (NADs) and other recommended treatments in people discharged following an NSTE-ACS according to the treatment strategy used, comparing the medium-term prognosis between groups.
Prospective observational multicenter registry study in 1717 patients discharged from hospital following an ACS; 1143 patients had experienced an NSTE-ACS. We analyzed groups receiving the following treatment: No cardiac catheterization (NO CATH): n = 134; 11.7%; Cardiac catheterization without revascularization (CATH-NO REVASC): n = 256; 22.4%; percutaneous coronary intervention (PCI): n = 629; 55.0%; and coronary artery bypass graft (CABG): n = 124; 10.8%. We assessed major adverse cardiovascular events (MACE), all-cause mortality, and hemorrhagic complications at one year.
NO CATH was the oldest, had the most comorbidities, and was at the highest risk for ischemic and hemorrhagic events. Few patients who were not revascularized with PCI received NADs (NO CATH: 3.7%; CATH-NO REVASC: 10.6%; PCI: 43.2%; CABG: 3.2%; p<0.001). Non-revascularized patients also received fewer beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB), and statins (p<0.001). At one year, MACE incidence in NO CATH group was three times that of the other groups (30.1%, p<0.001), and all-cause mortality was also much higher (26.3%, p<0.001). There were no significant differences in hemorrhagic events. Belonging to NO CATH group was an independent predictor for MACE at one year in the multivariate analysis (HR 2.72, 95% CI 1.29-5.73; p = 0.008).
Despite current invasive management of NSTE-ACS, patients not receiving catheterization are at very high risk for under treatment with recommended drugs, including NADs. Their medium-term prognosis is poor, with high mortality. Patients treated with PCI receive better pharmacological management, with high use of NADs.
非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）患者通常采用保守治疗。临床实践指南建议对接受侵入性治疗的患者和接受保守治疗的患者使用相同的药物。我们分析了根据治疗策略使用新抗血小板药物（NAD）和其他推荐治疗方法在出院后的 NSTE-ACS 患者中的应用，并比较了各组的中期预后。
对 1717 例 ACS 出院患者进行前瞻性观察性多中心登记研究；其中 1143 例患者发生 NSTE-ACS。我们分析了接受以下治疗的患者：无心脏导管检查（NO CATH）：n = 134；11.7%；无血运重建的心脏导管检查（CATH-NO REVASC）：n = 256；22.4%；经皮冠状动脉介入治疗（PCI）：n = 629；55.0%；和冠状动脉旁路移植术（CABG）：n = 124；10.8%。我们评估了一年时的主要不良心血管事件（MACE）、全因死亡率和出血并发症。
NO CATH 组年龄最大，合并症最多，发生缺血性和出血性事件的风险最高。未行 PCI 血运重建的患者很少使用 NAD（NO CATH：3.7%；CATH-NO REVASC：10.6%；PCI：43.2%；CABG：3.2%；p<0.001）。未行血运重建的患者也较少使用β受体阻滞剂、血管紧张素转换酶（ACE）抑制剂、血管紧张素 II 受体阻滞剂（ARB）和他汀类药物（p<0.001）。NO CATH 组一年时 MACE 发生率是其他组的三倍（30.1%，p<0.001），全因死亡率也明显更高（26.3%，p<0.001）。出血事件无显著差异。多因素分析显示，NO CATH 组是一年时 MACE 的独立预测因素（HR 2.72，95%CI 1.29-5.73；p = 0.008）。
尽管目前对 NSTE-ACS 进行了有创治疗，但未接受导管检查的患者接受推荐药物治疗，包括 NAD 治疗的风险非常高。他们的中期预后较差，死亡率较高。接受 PCI 治疗的患者接受了更好的药物治疗，NAD 的使用率较高。
