title: Comparison of Noninvasively and Invasively Managed Patients, With or Without Revascularization in Non-ST Elevation Myocardial Infarction (from the Acute Coronary Syndrome Israeli Survey).
abstract: Patients with non-ST elevation myocardial infarction who are managed noninvasively at presentation or are catheterized but without revascularization represent a heterogeneous and understudied population. We evaluated the clinical characteristics, management strategies, and outcomes of patients with non-ST elevation myocardial infarction (NSTEMI) who were enrolled in the prospective biannual Acute Coronary Syndrome Israeli Surveys from 2004 to 2013. Patients were divided into 3 groups: no catheterization (no angio), catheterization with revascularization (angio-revascularized), and catheterization without revascularization (angio-nonrevascularized) groups. The study included 3,198 patients with NSTEMI. Coronary angiography was performed in 2,525 (79%) during the index hospitalization, of whom 1899 (59%) underwent revascularization. Evidence-based therapies were administered during the index hospitalization at a significantly higher rate to those in the angio-revascularized group compared with the other 2 groups. Multivariate analysis showed that compared with those in the angio-revascularized and angio-nonrevascularized groups, patients in the no angio group experienced a significantly higher risk for 1-year mortality (hazard ratio 2.04 [p ≤0.0001] and 1.21 [p = 0.01], respectively). The risk associated with no revascularized was consistent in each risk subset analyzed, including an older age, and increased creatinine levels. In conclusion, our data, from a large real-world contemporary experience, suggest that patients with NSTEMI who do not undergo coronary revascularization during the index hospitalization represent a greater risk and undertreated group with increased risk for long-term mortality.
authors.affiliation: Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: alexb@asaf.health.gov.il.
authors.forename: Alex
authors.initials: A
authors.lastname: Blatt
authors.affiliation: Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Kalmanovich
authors.affiliation: Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Orit
authors.initials: O
authors.lastname: Karny-Rahkovich
authors.affiliation: Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Brener
authors.affiliation: The Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Meital
authors.initials: M
authors.lastname: Shlezinger
authors.affiliation: The Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Shlomo
authors.affiliation: Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Zvi
authors.initials: Z
authors.lastname: Vered
authors.affiliation: The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Hanoch
authors.initials: H
authors.lastname: Hod
authors.affiliation: The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Gabby
authors.initials: G
authors.lastname: Elbaz-Greener
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D015331:Cohort Studies; D017023:Coronary Angiography; D005260:Female; D006760:Hospitalization; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D000072658:Non-ST Elevated Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D012042:Registries; D011795:Surveys and Questionnaires; D016896:Treatment Outcome