title: Long-term prognosis of patients with acute non-ST-segment elevation myocardial infarction undergoing different treatment strategies.
abstract: BACKGROUND
  In cardiology, it is controversial whether different therapy strategies influence prognosis after acute coronary syndrome. We examined and compared the long-term outcomes of invasive and conservative strategies in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and characterized the patients selected for an invasive approach.
  
  
  METHODS
  A total of 976 patients with acute NSTEMI were collected from December 2006 to October 2012 in the First Affiliated Hospital of Dalian Medical University Hospital. They are divided into conservative strategy (586 patients) and invasive strategy (390 patients) group. Unified follow-up questionnaire was performed by telephone contact (cut-off date was November, 2013). The long-term clinical events were analyzed and related to the different treatment strategies.
  
  
  RESULTS
  The median follow-up time was 29 months. Mortality was 28.7% (n = 168) in the conservative group and 2.1% (n = 8) in the invasive management at long-term clinical follow-up. The secondary endpoint (the composite endpoint) was 59.0% (n = 346) in the conservative group and 30.3% (n = 118) in the invasive management. Multivariate analysis showed that patients in the conservative group had higher all-cause mortality rates than those who had the invasive management (adjusted risk ratio [RR] = 7.795; 95% confidence interval [CI]: 3.796-16.006, P < 0.001), and the similar result was also seen in the secondary endpoint (adjusted RR = 2.102; 95% CI: 1.694-2.610, P < 0.001). In the subgroup analysis according to each Thrombolysis in Myocardial Infarction risk score (TRS), log-rank analysis showed lower mortality and secondary endpoint rates in the invasive group with the intermediate and high-risk patients (TRS 3-7).
  
  
  CONCLUSIONS
  An invasive strategy could improve long-term outcomes for NSTEMI patients, especially for intermediate and high-risk ones (TRS 3-7).
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
authors.forename: Da-Peng
authors.initials: DP
authors.lastname: Shen
authors.forename: Xu-Chen
authors.initials: XC
authors.lastname: Zhou
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.forename: Rong-Chong
authors.initials: RC
authors.lastname: Huang
authors.forename: Yan-E
authors.initials: YE
authors.lastname: Wang
authors.forename: Ai-Ming
authors.initials: AM
authors.lastname: Chen
authors.forename: Ye-Ran
authors.initials: YR
authors.lastname: Zhu
authors.affiliation: Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Zhu
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies