More aggressive pharmacological treatment may improve clinical outcome in patients with non-ST-elevation acute coronary syndromes treated conservatively.
BACKGROUND
Increased adherence to guideline-recommended therapies, especially early invasive strategy introduction may improve clinical outcome in patients with non-ST-elevation acute coronary syndromes. The aim of this study was to assess the impact of more aggressive pharmacological treatment and application of current guidelines in everyday clinical practice in hospitals without on-site invasive facility, with a special focus on its influence on in-hospital mortality in non-ST-elevation acute coronary syndromes patients.


METHODS
We identified 807 non-ST-elevation acute coronary syndromes patients treated conservatively in the 29 hospitals participating in the Malopolska Registry of Acute Coronary Syndromes from February to March 2005 and from December 2005 to January 2006. For all patients, pharmacotherapy index based on the use of pharmacological treatment regimen during hospital stay was assessed. Each patient received 1 point for each of the following guideline-recommended drugs used: aspirin, clopidogrel, glycoprotein IIb/IIIa inhibitor, low-molecular-weight heparin, beta-blocker, angiotensin converting enzyme inhibitor/angiotensin II receptor blocker, statin - range of points from 0 to 7.


RESULTS
The in-hospital mortality decreased with increase of pharmacotherapy index (0 points - 80.0%, 1 point - 36.4%, 2 points - 17.4%, 3 points - 7.6%, 4 points - 5.6%, 5 points - 1.7%, 6 points - 0.0%; P<0.0001, total mortality-5.3%). Independent predictors of in-hospital death were cardiogenic shock, thrombolysis in myocardial infarction (TIMI) risk score, renal insufficiency and pharmacotherapy index.


CONCLUSIONS
Our findings support the need for more aggressive pharmacological treatment of patients with non-ST-elevation acute coronary syndromes remaining in community hospitals for conservative treatment. Broader implementation of current guidelines and more frequent invasive treatment could improve the outcomes of non-ST-elevation acute coronary syndromes patients.
Dziewierz
Artur
A
Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Siudak
Zbigniew
Z
Rakowski
Tomasz
T
Mielecki
Waldemar
W
Giszterowicz
Dawid
D
Dubiel
Jacek S
JS
Dudek
Dariusz
D
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome
D002317:Cardiovascular Agents