title: Invasive strategies and outcomes for non-ST-segment elevation acute coronary syndromes: a twelve-year experience from SWEDEHEART.
abstract: OBJECTIVE
  Despite recommendations in recent guidelines for a routine invasive strategy for non-ST-segment elevation acute coronary syndrome (NSTE-ACS), long-term data on the implementation of treatment strategies in clinical practice are not available. Our aim was to provide long-term data on the implementation of a routine invasive strategy in NSTE-ACS in clinical practice.
  
  
  RESULTS
  In the SWEDEHEART registry, data from 204,092 consecutive NSTE-ACS patients admitted between 1996 and 2007 were recorded. The use of the routine invasive strategy, retrospectively defined as coronary angiography (and subsequent revascularisation) within three days after admission, increased from 3.8% in the period 1996-1998 to 37.4% in the period 2005-2007. The largest absolute increase in the use of this strategy was observed in low-risk patients, while a similar relative increase was observed in all risk categories. The use of the selective invasive strategy, defined as coronary angiography later than three days after admission or none at all, decreased from 96.2% in the period 1996-1998 to 62.5% in the period 2005-2007. In the total population, there was a gradual decrease in three-year all-cause mortality, from 29.1% in the period 1996-1998 to 23.9% in the period 2005-2007.
  
  
  CONCLUSIONS
  There has been an increase in the use of a routine invasive strategy in NSTE-ACS patients over the course of 12 years in Sweden. There was a decrease in three-year mortality over the same time course.
authors.affiliation: Uppsala Clinical Research Centre, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Damman
authors.forename: Tomas
authors.initials: T
authors.lastname: Jernberg
authors.forename: Bertil
authors.initials: B
authors.lastname: Lindahl
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
authors.forename: Anders
authors.initials: A
authors.lastname: Jeppsson
authors.forename: Per
authors.initials: P
authors.lastname: Johanson
authors.forename: Claes
authors.initials: C
authors.lastname: Held
authors.forename: Stefan K
authors.initials: SK
authors.lastname: James
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D002423:Cause of Death; D015897:Comorbidity; D017023:Coronary Angiography / Q000639:trends*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D000072658:Non-ST Elevated Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000639:trends*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D061665:Time-to-Treatment