title: Differential prognostic effect of revascularization according to a simple comorbidity index in high-risk non-ST-segment elevation acute coronary syndrome.
abstract: BACKGROUND
  Data on the effect of revascularization on outcome in patients with high-risk non-ST-segment elevation acute coronary syndrome (NSTEACS) and significant comorbidities are scarce. Recently, a simple comorbidity index (SCI) including 5 comorbidities (renal failure, dementia, peripheral artery disease, heart failure, and prior myocardial infarction [MI]) has shown to be a useful tool for risk stratification. Nevertheless, therapeutic implications have not been derived.
  
  
  OBJECTIVE
  We sought to evaluate the prognostic effect attributable to revascularization in NSTEACS according the SCI score.
  
  
  METHODS
  We included 1017 consecutive patients with NSTEACS. The effect of revascularization on a combined end point of all-cause mortality or nonfatal MI was evaluated by Cox regression according to SCI categories.
  
  
  RESULTS
  A total of 560 (55.1%), 236 (23.2%), and 221 (21.7%) patients showed 0, 1, and ≥2 points according to the SCI, respectively. Coronary angiography was performed in 725 patients (71.5%), and 450 patients (44.3%) underwent revascularization. During a median follow-up of 16 months (interquartile range, 12-36 months), 305 (30%) patients experienced the combined end point (202 deaths [19.9%] and 170 MIs [16.7%]). In multivariate analysis, a differential prognostic effect of revascularization was observed comparing SCI ≥2 vs 0 (P for interaction = 0.008). Thus, revascularization was associated with a greater prognostic benefit in patients with SCI ≥2 (hazard ratio [HR]: 0.51, 95% confidence interval [CI]: 0.29-0.89), P = 0.018), whereas no significant benefit was observed in those with 0 and 1 point (HR: 1.31, 95% CI: 0.88-1.94, P = 0.171 and HR: 1.11, 95% CI: 0.70-1.76, P = 0.651, respectively).
  
  
  CONCLUSIONS
  In NSTEACS, the SCI score appears to be a useful tool for identifying a subset of patients with a significant long-term death/MI risk reduction attributable to revascularization.
authors.affiliation: Cardiology Department, Hospital Clinico Universitario, INCLIVA, Universidad de Valencia, Valencia, Spain. patri.palau@gmail.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: Oliver
authors.initials: O
authors.lastname: Husser
authors.forename: Vicente
authors.initials: V
authors.lastname: Bodí
authors.forename: Eduardo
authors.initials: E
authors.lastname: Núñez
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.forename: Line
authors.initials: L
authors.lastname: Boesen
authors.forename: Silvia
authors.initials: S
authors.lastname: Ventura
authors.forename: Angel
authors.initials: A
authors.lastname: Llàcer
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D000368:Aged; D015897:Comorbidity; D016001:Confidence Intervals; D003657:Decision Making; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D013030:Spain; D013223:Statistics as Topic; D013997:Time Factors; D014336:Troponin / Q000097:blood
chemical_list: D014336:Troponin
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