title: Editor's Choice-Medically managed patients with non-ST-elevation acute myocardial infarction have heterogeneous outcomes, based on performance of angiography and extent of coronary artery disease.
abstract: BACKGROUND
  Medically managed individuals represent a high-risk group among patients with non-ST-elevation acute myocardial infarction (NSTE-AMI). We hypothesized that prognosis in this group is heterogeneous, depending on whether medical management was decided with or without coronary angiography (CAG).
  
  
  METHODS
  Using data from the French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction (FAST-MI), we analysed data from 798 patients with NSTE-AMI who were medically managed (i.e. without revascularization during the index hospitalization). Patients were categorized according to the performance of CAG and, if performed, to the extent of coronary artery disease (CAD).
  
  
  RESULTS
  There were marked differences in baseline demographics, according to whether CAG was performed and to the extent of CAD. While the overall mortality rate at five years was high (56.2%), it differed greatly between groups, with patients who did not undergo CAG having a higher mortality rate (77.4%) than patients who underwent CAG (36.7%, p<0.001), and a higher mortality rate even than patients with multivessel CAD (54.2%, p<0.001). By multivariable analysis, non-performance of CAG was an independent predictor of all-cause mortality among medically managed NSTE-AMI patients (adjusted hazard ratios (95% confidence intervals) 3.19 (1.79-5.67) at 30 days, 2.28 (1.60-3.26) at one year, and 1.63 (1.28-2.07) at five years; all p<0.001).
  
  
  CONCLUSIONS
  Medically managed patients with NSTE-AMI are a heterogeneous group in terms of baseline characteristics and outcomes. The highest risk patients are those who do not undergo CAG. Non-performance of CAG is a strong predictor of death. (FAST-MI, NCT00673036).
authors.affiliation: 1 Département de Cardiologie, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), France.|4 French Alliance for Cardiovascular Clinical Trials (FACT), France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Feldman
authors.affiliation: 1 Département de Cardiologie, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), France.|5 Imperial College, Royal Brompton Hospital, London, UK.
authors.forename: Philippe G
authors.initials: PG
authors.lastname: Steg
authors.affiliation: 1 Département de Cardiologie, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), France.
authors.forename: Myriam
authors.initials: M
authors.lastname: Amsallem
authors.affiliation: 4 French Alliance for Cardiovascular Clinical Trials (FACT), France.|6 Hôpital Européen Georges Pompidou, APHP, France.|7 Université Paris Descartes, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Puymirat
authors.affiliation: 1 Département de Cardiologie, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), France.|3 U1148, Institut National de la Santé et de la Recherche Médicale (INSERM) INSERM, France.|4 French Alliance for Cardiovascular Clinical Trials (FACT), France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Sorbets
authors.affiliation: 4 French Alliance for Cardiovascular Clinical Trials (FACT), France.|8 Hôpital Rangueil, Toulouse, France.
authors.forename: Meyer
authors.initials: M
authors.lastname: Elbaz
authors.affiliation: 9 Hôpital St Joseph et St Luc, Lyon, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Ritz
authors.affiliation: 10 Clinique Claude Bernard, Metz, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Hueber
authors.affiliation: 4 French Alliance for Cardiovascular Clinical Trials (FACT), France.|11 Hôpital Le Raincy-Montfermeil, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Cattan
authors.affiliation: 12 Clinique du Millénaire, Montpellier, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Piot
authors.affiliation: 8 Hôpital Rangueil, Toulouse, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrières
authors.affiliation: 3 U1148, Institut National de la Santé et de la Recherche Médicale (INSERM) INSERM, France.|4 French Alliance for Cardiovascular Clinical Trials (FACT), France.|13 Département de Pharmacologie Clinique, Hôpital Saint-Antoine, APHP, France.|14 Université Pierre et Marie Curie, France.
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
authors.affiliation: 4 French Alliance for Cardiovascular Clinical Trials (FACT), France.|6 Hôpital Européen Georges Pompidou, APHP, France.|7 Université Paris Descartes, France.|14 Université Pierre et Marie Curie, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D000072658:Non-ST Elevated Myocardial Infarction / Q000188:drug therapy*; D010343:Patient Admission; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: Non–ST-elevation acute coronary syndrome; angiography; medical management; myocardial infarction; revascularization