title: Use of invasive strategy in non-ST-segment elevation myocardial infarction is a major determinant of improved long-term survival: FAST-MI (French Registry of Acute Coronary Syndrome).
abstract: OBJECTIVE
  This study sought to assess the impact of invasive strategy (IS) versus a conservative strategy (CS) on in-hospital complications and 3-year outcomes in patients with non-ST-segment elevation myocardial infarction (NSTEMI) from the FAST-MI (French Registry of Acute Coronary Syndrome).
  
  
  BACKGROUND
  Results from randomized trials comparing IS and CS in patients with NSTEMI are conflicting.
  
  
  METHODS
  Of the 3,670 patients in FAST-MI, which included patients with acute myocardial infarction (within 48 h) over a 1-month period in France at the end of 2005, 1,645 presented with NSTEMI.
  
  
  RESULTS
  Of the 1,645 patients analyzed, 80% had an IS. Patients in the IS group were younger (67 ± 12 years vs. 80 ± 11 years), less often women (29% vs. 51%), and had a lower GRACE (Global Registry of Acute Coronary Events) risk score (137 ± 36 vs. 178 ± 34) than patients treated with CS. In-hospital mortality and blood transfusions were significantly more frequent in patients with CS versus IS (13.1% vs. 2.0%, 9.1% vs. 4.6%). Use of IS was associated with a significant reduction in 3-year mortality and cardiovascular death (17% vs. 60%, adjusted hazard ratio [HR]: 0.44, 95% confidence interval [CI]: 0.35 to 0.55 and 8% vs. 36%, adjusted HR: 0.37, 95% CI: 0.27 to 0.50). After propensity score matching (181 patients per group), 3-year survival was significantly higher in patients treated with IS.
  
  
  CONCLUSIONS
  In a real-world setting of patients admitted with NSTEMI, the use of IS during the initial hospital stay is an independent predictor of improved 3-year survival, regardless of age. (French Registry of Acute Coronary Syndrome [FAST-MI]; NCT00673036).
authors.affiliation: Division of Coronary Artery Disease and Intensive Cardiac Care, European Hospital of Georges Pompidou, Assistance Publique des Hôpitaux de Paris (AP-HP), University Paris Descartes, Paris, France. etiennepuymirat@yahoo.fr
authors.forename: Etienne
authors.initials: E
authors.lastname: Puymirat
authors.forename: Guillaume
authors.initials: G
authors.lastname: Taldir
authors.forename: Nadia
authors.initials: N
authors.lastname: Aissaoui
authors.forename: Gilles
authors.initials: G
authors.lastname: Lemesle
authors.forename: Luc
authors.initials: L
authors.lastname: Lorgis
authors.forename: Thomas
authors.initials: T
authors.lastname: Cuisset
authors.forename: Pierre
authors.initials: P
authors.lastname: Bourlard
authors.forename: Bruno
authors.initials: B
authors.lastname: Maillier
authors.forename: Gregory
authors.initials: G
authors.lastname: Ducrocq
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrieres
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D005260:Female; D005602:France; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents