[Clinical characteristics, in-hospital outcomes and predictors of in-hospital mortality in patients with acute coronary syndromes without persistent ST-segment elevation assigned to early invasive treatment strategy].
BACKGROUND
Early invasive strategy is one of alternative methods for management of acute coronary syndromes (ACS) without persistent ST-segment elevation.


OBJECTIVE
The aim of the study was analysis of clinical characteristics, in-hospital outcome and factors of in-hospital mortality.


METHODS
The study group comprised 853 patients who were defined as high-risk, based on resting pain episodes within previous 24 hours, changes of ST-T segment in ECG, and elevated serum cardiac markers. All patients underwent coronary angiography followed by PCI (percutaneous coronary interventions) in 73.1% of patients. 16.7% were assigned to CABG (coronary artery bypass graft), 1.6% of patients underwent PCI and CABG and 8.6% of patients were treated conservatively.


RESULTS
Overall in-hospital mortality was 3%; 1.4% in the PCI group, 8.4% in the CABG group and 6.8% in conservatively treated patients. The independent risk factors of in-hospital deaths were: Braunwald's IIIC class angina (OR 7.8; 95%CI 3.6-12.37 p=0.004), recurrent angina after revascularization (OR 13.04; 95%CI 7.62-29.23 p=0.002), congestive heart failure (OR 11.45; 95%CI 8.01-18,38 p=0.00001) and evolving myocardial infarction with ST-segment elevation (OR 12.77; 95%CI 8.35-27.35 p=0.0001). Stent implantation was associated with decreased risk of in-hospital death (OR 0.12; 95%CI 0.07-0.41; p=0.003).


CONCLUSIONS
Early invasive strategy in patients with ACS without ST-segment elevation is efficacious method of treatment. Independent predictors of in-hospital deaths are: Braunwald's IIIC class angina, congestive heart failure, recurrent angina after revascularization, myocardial infarction complicating hospital course. Stent implantation improves in-hospital prognosis.
Szyguła-Jurkiewicz
Bozena
B
III Katedra i Oddział Kliniczny Kardiologii, Slaskiej Akademii Medycznej, Kierownik Kliniki. b.szygula@sccs.pl
Wojnicz
Romuald
R
Trzeciak
Przemysław
P
Niklewski
Tomasz
T
Zembala
Marian
M
Poloński
Lech
L
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000401:mortality / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D016001:Confidence Intervals; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D009204:Myocardial Revascularization; D016017:Odds Ratio; D011044:Poland / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome