[Evaluation of early invasive or initially conservative strategies in patients with non-ST-segment elevation acute coronary syndrome at intermediate or high risk].
OBJECTIVE
To demonstrate the effect of early strategies and revascularization patterns on in-hospital major adverse cardiac events (MACE) in patients with non-ST-segment elevation acute coronary syndrome (ACS) at intermediate or high risk.


METHODS
910 Patients with non-ST-segment elevation ACS at intermediate or high risk were divided into either early invasive (n = 237) or initially conservative (n = 673) group according to whether or when coronary angiography (CAG) was performed after admission (<or= 48 h or > 48 h) in order to demonstrate the impact of early strategies and revascularization patterns on in-hospital MACE events (death, new-onset myocardial infarction or repeat revascularization).


RESULTS
Compared with those of the initially conservative group, patients in the early invasive group had a shorter hospital stay and increased rate of MACE (6.3% vs 2.5%, OR 0.384, 95% CI 0.188 - 0.781, P = 0.006) or new-onset myocardial infarction (4.6% vs 0.9%, OR 0.185, 95% CI 0.068 - 0.505, P = 0.001), which was partly due to increased procedures of revascularization (86.9% vs 67.5%, P < 0.001). No differences were found among in-hospital mortality or rate of repeat revascularization between the two groups. During subgroup analysis, patients receiving PCI in the early invasive or initially conservative group had comparable rates of new-onset myocardial infarction, repeat revascularization or MACE events, whereas patients receiving CABG in the early invasive group had a higher rate of new-onset myocardial infarctions than those in the initially conservative group (7.5% vs 1.8%, P = 0.027).


CONCLUSIONS
An early invasive strategy in patients with non-ST-segment elevation ACS had comparable in-hospital mortality and higher rate of in-hospital myocardial infarction compared with an initially conservative strategy, an early invasive strategy with PCI seems safe and feasible without increased risk of adverse clinical events. The impact of early CABG on in-hospital adverse events warrants further investigation.
Nie
Shao-ping
SP
Department of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Sciences, Beijing 100029, China.
Ma
Chang-sheng
CS
Lü
Qiang
Q
Zhang
Yin
Y
Du
Xin
X
Kang
Jun-ping
JP
Hao
Peng
P
Liu
Tong
T
Wang
Su
S
Dong
Jian-zeng
JZ
Liu
Xiao-hui
XH
Wu
Xue-si
XS
D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D009204:Myocardial Revascularization