Mode and timing of treatment failure (recurrent ischemic events) after hospital admission for non-ST segment elevation acute coronary syndromes.
BACKGROUND
Clarification of the specific clinical course of non-ST-segment elevation acute coronary syndromes (NSTEMI ACS), including recurrent ischemic events and need for coronary revascularization, is important given the increasing economic pressure to shorten the length of hospitalization and therefore the duration of acute therapy. To examine the mode and timing of subsequent cardiac events, we analyzed pooled data from the ESSENCE and TIMI 11B studies of antithrombotic therapy in NSTEMI ACS.


METHODS
The daily event rates (with confidence intervals) during the first 43 days and the monthly average event rates during the first year were tabulated for 7081 patients.


RESULTS
The median antithrombotic treatment duration was 3.2 days, whereas the highest absolute frequency of recurrent angina prompting urgent revascularization, myocardial infarction, or death after hospital admission occurred on day 2, day 3, and day 8, respectively. Coronary revascularization was performed in 32% of patients, with the greatest number occurring on day 4. Only 12% of the end point events were adjudicated as being periprocedural. The median length of hospital stay was 7 days.


CONCLUSIONS
Despite aggressive antithrombotic therapy, a significant proportion of patients with NSTEMI ACS have recurrent ischemia precipitating urgent revascularization or infarction within the first few days, whereas the highest risk of death occurs later, after the first week.
Cohen
Marc
M
Division of Cardiology, MCP-Hahnemann University School of Medicine, Philadelphia, Pennsylvania, USA. marc.cohen@tenethealth.com
Antman
Elliott M
EM
Murphy
Sabina A
SA
Radley
David
D
D000787:Angina Pectoris / Q000209:etiology; D002423:Cause of Death; D016001:Confidence Intervals; D004311:Double-Blind Method; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D017202:Myocardial Ischemia / Q000188:drug therapy* / Q000401:mortality; D009204:Myocardial Revascularization / Q000401:mortality; D016017:Odds Ratio; D011446:Prospective Studies; D012008:Recurrence; D015912:Thrombolytic Therapy; D017211:Treatment Failure