Non-Invasively and Invasively Managed Patients, with or qithout Revascularization: Presentation, Management Outcome and Temporal Trends in Non-ST Elevation Myocardial Infarction: Results from the ACSIS Survey

Alex Blatt 1,3 Avi Mizrahi 1,3 Eran Kalmanovich 1,3 Svetlana Brener 1,3 Meital Shlezinger 2,3 Zvi Vered 1,3 Hanoch Hod 2,3 Ilan Goldenberg 2,3 Gabby Elbaz-Greener
1Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel
2Chaim Sheba Medical Center, The Heart Center, Tel Hashomer, Israel
3Tel Aviv University, The Sackler Faculty of Medicine, Tel Aviv, Israel

Background: Patients with non-ST elevation myocardial infarction (NSTE-MI) who are managed non-invasively at presentation or catheterized but without revascularization, have a high rate of adverse events and represent a heterogeneous and understudied population.

Methods: We performed a retrospective analysis on the clinical characteristics, management strategies, time-dependent trends and outcomes of patients enrolled in the biannual Acute Coronary Syndrome Israeli Surveys (ACSIS) between 2004 and 2013. Patients were divided into 2 groups: No catheterization (NA), and catheterization (A) with further sub-division into revascularization (AR) and no revascularization (ANR).

Results: Among 6088 patients enrolled, 3268 (53.7%) were diagnosed as NSTE-MI at hospitalization discharge. During the initial hospitalization coronary angiography was performed in 2579 patients (78.92%) of whom 1943 (59.45%) underwent revascularization. The clinical risk profile of the NA group was significantly higher than the A group. Evidence based therapies during hospitalization and discharge were significantly more often offered to the AR group than the NA and the ANR groups respectively. The mortality was higher in all these periods in the NA compared with the A group (p<0.001). When compared the revascularized and no-revascularized groups the reduction There was a significant reduction in mortality at 30 days and one year between the AR and ANR groups, but there was no difference in 30 days MACE. The long-term outcome trends maintained at 3 years, with improved mortality and MACE reduction in the A group and AR groups, as compared with the NA group (p<0.001). – Figure 1

Conclusion: This study highlights different subgroups in NSTEMI cohort based on the strategies adopted according to different patient characteristics and clinical needs. Patients undergoing revascularization (AR) had the best outcome, while those treated conservatively (NA) had the worst prognosis.









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