Characteristics and outcomes of medically managed patients with non-ST-segment elevation acute coronary syndromes: Insights from the multinational EPICOR Asia study

被引:16
作者
Chin, Chee Tang [1 ]
Ong, Tiong K. [2 ]
Krittayaphong, Rungroj [3 ]
Lee, Stephen W. -L. [4 ]
Sawhney, Jitendra P. S. [5 ]
Kim, Hyo-Soo [6 ]
Garcia, Angeles Alonso [7 ]
Bueno, Hector [8 ,9 ,10 ,11 ]
Pocock, Stuart J. [12 ]
Nhan, Vo T. [13 ]
Vega, Ana [14 ]
Hayashi, Nobuya [15 ]
Huo, Yong [16 ]
机构
[1] Natl Heart Ctr Singapore, Singapore, Singapore
[2] Sarawak Gen Hosp, Kuching, Malaysia
[3] Siriraj Hosp, Bangkok, Thailand
[4] Queen Mary Hosp, Hong Kong, Hong Kong, Peoples R China
[5] Sir Ganga Ram Hosp, New Delhi, India
[6] Seoul Natl Univ Hosp, Seoul, South Korea
[7] St Georges Univ London, Cardiovasc Sci Res Ctr, London, England
[8] Ctr Nacl Invest Cardiovasc, Madrid, Spain
[9] Hosp Univ 12 Octubre, Inst Invest I 12, Madrid, Spain
[10] Hosp Univ 12 Octubre, Cardiol Dept, Madrid, Spain
[11] Univ Complutense Madrid, Madrid, Spain
[12] London Sch Hyg & Trop Med, London, England
[13] Cho Ray Hosp, Ho Chi Minh City, Vietnam
[14] AstraZeneca, Madrid, Spain
[15] AstraZeneca, Osaka, Japan
[16] Peking Univ, Hosp 1, Beijing, Peoples R China
关键词
Acute coronary syndromes; Asia; Medical management; Long-term outcomes; TERM-FOLLOW-UP; UNSTABLE ANGINA; PATTERNS; STRATEGIES; PREDICTORS;
D O I
10.1016/j.ijcard.2017.04.059
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Many patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) are medically managed without coronary revascularization. The reasons vary and may impact prognosis. Methods: EPICOR Asia (NCT01361386) is a prospective study of hospital survivors post-ACS enrolled in 218 hospitals from8 countries/ regions in Asia (06/ 2011-05/ 2012). All medicallymanaged NSTE-ACS patientswere classified into 3 groups: 1) no coronary angiography (CAG-); 2) non-significant coronary artery disease (CAD) on angiogram(CAG+ CAD-); and 3) significant CAD (CAG+ CAD+). We compared baseline differences between patients medically managed and patients undergoing revascularization, and also between the medically managed groups. Adverse events were reported and compared up to 2 years. Results: Of 6163 NSTE-ACS patients, 2272 (37%) were medicallymanaged, with 1339 (59%), 254 (11%), and 679 (30%) in the CAG-, CAG+ CAD-, and CAG+ CAD+ groups, respectively. Thereweremarked differences in the proportion of medicallymanaged patients among the 8 countries/ regions (13-81%). Medically managed patients had higher mortality at 2 years compared with revascularization (8.7% vs. 3.0%, p b 0.001). Among medically managed patients, CAG-patients were older, more likely to have pre-existing cardiovascular disease, and had the highest 2-yearmortality (10.5% vs. 4.3% [CAG+ CAD-] and 6.6% [CAG+ CAD+], p b 0.001). Mortality differences persisted after adjusting for other patient risk factors. Conclusions: Medically managed NSTE-ACS patients are a heterogeneous group with different risk stratification and variable prognosis. Identification of reasons underlying different management strategies, and key factors adversely influencing long-term prognosis, may improve outcomes. (C) 2017 Elsevier B. V. All rights reserved.
引用
收藏
页码:15 / 20
页数:6
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