title: Coronary revascularisation in stable patients after an acute coronary syndrome: a propensity analysis of early invasive versus conservative management in a register-based cohort study.
abstract: OBJECTIVE
  To compare the effectiveness of in-hospital medical therapy versus coronary revascularisation added to medical therapy in patients who stabilised after an acute coronary syndrome (ACS).
  
  
  METHODS
  Propensity score-matched cohort study from the database of the Tampere ACS registry.
  
  
  METHODS
  A single academic hospital in Finland.
  
  
  METHODS
  1149 patients with a recent ACS, but no serious coexisting conditions: recurrent ischaemic episodes despite adequate medical therapy, haemodynamic instability, overt congestive heart failure and serious ventricular arrhythmias.
  
  
  METHODS
  The composite endpoint of major acute cardiovascular events (MACEs): unstable angina requiring rehospitalisation, stroke, myocardial infarction and all-cause mortality, at 6-month follow-up.
  
  
  RESULTS
  Compared with standard medical treatment, revascularisation was associated with a lower rate of MACEs at 6 months in patients of the first quintile (HR 0.81; 95% CI 0.66 to 0.99), but a higher rate of MACEs in the fifth quintile (HR 4.74, CI 1.36 to 16.49; p=0.014). There were no significant differences in the rates of MACEs in the remaining three quintiles. Patients of the first quintile were the oldest (79.7±8.3 years) and had a more significant (p<0.001) history of prior myocardial infarction (37%) and poor renal function (creatine, µmol/l: 114.9±70.7). They also showed the highest C reactive protein (7.3±9.5 mg/l) levels.
  
  
  CONCLUSIONS
  Our findings suggest that in-hospital coronary revascularisation did not lead to any advantage with signal of possible harm in the great majority of patients who stabilised after an ACS. An early invasive management strategy may be best reserved for elderly patients having high-risk clinical features and biochemical evidence of a strong inflammatory activity.
authors.affiliation: Experimental, Diagnostic and Speciality Medicine, University of Bologna, Bologna, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Bugiardini
authors.forename: Markku
authors.initials: M
authors.lastname: Eskola
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.forename: Kari
authors.initials: K
authors.lastname: Niemelä
authors.forename: Pekka
authors.initials: P
authors.lastname: Karhunen
authors.forename: Rossella
authors.initials: R
authors.lastname: Miglio
authors.forename: Olivia
authors.initials: O
authors.lastname: Manfrini
authors.forename: Carmine
authors.initials: C
authors.lastname: Pizzi
authors.forename: Kjell
authors.initials: K
authors.lastname: Nikus