[Percutaneous and surgical revascularization in acute coronary syndromes without persistent ST segment elevation. One-year outcome of 361 patients assigned to early invasive strategy].
BACKGROUND
Percutaneous coronary interventions (PCI) and coronary artery bypass grafting (CABG) are well established revascularization methods in stable coronary artery disease and in acute coronary syndromes (ACS) as well.


METHODS
We analyzed 361 patients hospitalized with clinical diagnosis of ACS without persistent ST segment elevation. Patients had an episode of rest angina in the previous 24 hours and had to fulfil at least one of the criteria: 1. ST segment depression (>0.5 mm), 2. transient ST segment elevation or T-wave inversion (> 1 mm), 3. positive serum cardiac markers. We aimed at assessing the frequency of adverse events (death, myocardial infarction, repeat revascularization unstable angina, cardiovascular hospitalization) during follow-up and determining the predictors of 12-month mortality.


RESULTS
In the analyzed group 284 patients (78.7%) underwent PCI and 77 patients (21.3%) were assigned to CABG. Overall mortality in the PCI group and in the CABG group was 3.5% and 9.1% respectively (p=0.04). In-hospital mortality rate was higher in the CABG group (7.8% vs. 1.8% p<0.02). After discharge mortality rate was 1.8% in the PCI and 1.4% in the CABG group (NS). The rate of MI during follow-up was similar in both groups. Fewer CABG patients had episodes of unstable angina, MI, repeat revascularization and cardiovascular hospitalisation. Independent predictors of death in the PCI group were: post-procedure recurrent angina (OR 2.40; 95%CI 1.20-4.19; p=0.03) and heart failure (OR 4.75; 95%CI 1.80-12.70; p=0.01), while in the CABG group these predictors were: inability to determine culprit vessel (OR 4,29; 95%CI 2.20-15.6; p=0.02) and heart failure (OR 7.70; 95%CI 3.74-21.49; p=0.05).


CONCLUSIONS
We observed a higher overall mortality rate at one year in CABG patients, whereas PCI patients had a higher rate of unstable angina, repeat revascularization and cardiovascular hospitalization during 12-month follow-up.
Szyguła-Jurkiewicz
Bozena
B
III Katedra i Oddział Kliniczny Kardiologii, Slaskiej Akademii Medycznej. b.szygula@sccs.pl
Wilczek
Krzysztof
K
Przybylski
Roman
R
Pacholewicz
Jerzy
J
Trzeciak
Przemysław
P
Styn
Tomasz
T
Zembala
Marian
M
Poloński
Lech
L
D000208:Acute Disease; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D001026:Coronary Artery Bypass / Q000295:instrumentation*; D003327:Coronary Disease / Q000503:physiopathology* / Q000534:rehabilitation / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D012146:Rest; D012848:Sinoatrial Block / Q000503:physiopathology*; D016896:Treatment Outcome