title: Effect of invasive treatment on prognosis in non-ST-segment elevation acute coronary syndrome with or without systolic dysfunction.
abstract: OBJECTIVE
  Few data are available on the use of invasive treatment in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) and systolic dysfunction. The aim of this study was to determine the effect of invasive treatment on the prognosis of patients with NSTEACS, with or without systolic dysfunction.
  
  
  METHODS
  The study included 972 consecutive patients admitted for NSTEACS (i.e. ST-segment depression or an elevated troponin-I level). Systolic dysfunction was defined as an ejection fraction <50% on transthoracic echocardiography. The primary long-term endpoint was death or myocardial infarction. The effect of invasive treatment on prognosis was evaluated by Cox regression analysis.
  
  
  RESULTS
  Overall, 23.4% of patients had systolic dysfunction, and 303 (31.2%) reached the primary endpoint, which was more frequent in those with systolic dysfunction (49.8% vs. 25.5%; P< .001). Usage of coronary angiography and revascularization procedures were similar in patients with systolic dysfunction and those with an ejection fraction >/=50% (59% vs. 63.4%; P=.239; and 38.3% vs. 38.8%; P=.9; respectively). Detailed adjusted multivariate analysis, including the use of a propensity score, demonstrated that coronary angiography had a differential effect on prognosis depending on the presence or absence of systolic dysfunction (interaction, P=.01). Catheterization was clearly beneficial in patients with systolic dysfunction (hazard ratio [HR]=0.47; 95% confidence interval [CI], 0.3-0.75; P=.001) but not in those with an ejection fraction >/=50% (HR=0.9; 95% CI, 0.63-1.29; P=.567).
  
  
  CONCLUSIONS
  The presence of systolic dysfunction identifies those patients with NSTEACS who will benefit most from invasive treatment.
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, INCLIVA, Valencia, España. patricia.palau@hotmail.com
authors.forename: Patricia
authors.initials: P
authors.lastname: Palau
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Vicent
authors.initials: V
authors.lastname: Bodí
authors.forename: Eva
authors.initials: E
authors.lastname: Rumiz
authors.forename: Eduardo
authors.initials: E
authors.lastname: Núñez
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.forename: Pilar
authors.initials: P
authors.lastname: Merlos
authors.forename: Cristina
authors.initials: C
authors.lastname: Gómez
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fácila
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
authors.forename: Angel
authors.initials: A
authors.lastname: Llàcer
mesh_terms: D054058:Acute Coronary Syndrome / Q000503:physiopathology / Q000601:surgery*; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization; D011379:Prognosis; D013599:Systole