A conservative strategy in non-ST-segment elevation myocardial infarction - constraints and prognosis: The situation in Portugal.
OBJECTIVE
The aim of this study was to assess the impact of a conservative strategy in non-ST-segment elevation myocardial infarction in patients in the Portuguese Registry of Acute Coronary Syndromes.


METHODS
The 3780 patients included in the study over a three-year period were divided into three groups: group 1, patients treated by a conservative strategy during hospitalization; group 2, patients who underwent coronary angiography without percutaneous coronary intervention (PCI); and group 3, patients who underwent PCI. Clinical and procedural data and in-hospital complications were compared. The primary endpoint was defined as in-hospital or one-year mortality and the secondary endpoint as the presence of at least one of the following in-hospital complications: major bleeding according to the GUSTO criteria, need for blood transfusion, invasive ventilation, heart failure or reinfarction.


RESULTS
Of the patients analyzed, 16.5% were treated by a conservative strategy. Patients in this group were older, more often women, and had more high-risk factors. A conservative strategy was associated with a higher rate of the primary endpoint - in-hospital mortality (10.6% vs. 1.1% vs. 0.6% in groups 1, 2 and 3, respectively, p<0.001, odds ratio (OR) 6.974, 95% confidence interval [CI]: 2.775-17.527) and one-year mortality (26.1% vs. 6.8% vs. 4.1%, p<0.001, hazard ratio (HR) 2.925, 95% CI: 1.433 -5.974) - and of the secondary endpoint - 37.2% vs. 18.9% vs. 14.6%, p<0.001; OR 1.471 95% CI: 1.043 -2.076.


CONCLUSIONS
In this patient population, a conservative strategy is an independent predictor of in-hospital mortality, in-hospital complications and one-year mortality.
Serviço de Cardiologia, Centro Hospitalar Tondela-Viseu, Viseu, Portugal. Electronic address: davidasmoreira@gmail.com.
Davide
D
Moreira
Serviço de Cardiologia, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
Bruno
B
Marmelo
Serviço de Cardiologia, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
Anne
A
Delgado
Serviço de Cardiologia, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
Luís
L
Nunes
Serviço de Cardiologia, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
João
J
Pipa
Serviço de Cardiologia, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
Oliveira
O
Santos
D000368:Aged; D000072700:Conservative Treatment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D011174:Portugal; D011379:Prognosis
Conservative strategy; Enfarte agudo do miocárdio sem supradesnivelamento de ST; Estratégia conservadora; Non‐ST elevation myocardial infarction; Prognosis; Prognóstico