Abstract 5592: In Acute Coronary Syndromes Being Totally Revascularized Is As Good As Having A Normal Coronary Angiogram
Background: Revascularization is a crucial therapy in acute coronary syndromes (ACS). Purpose: to assess ACS patients outcomes, stratified according to the coronary angiography and/or angioplasty.
Population and methods: 786 consecutive ACS patients submitted to an invasive strategy, divided in 3 groups: A (n=111) normal coronary angiogram; B (n=327) fully revascularized; C (n=348) incomplete revascularization. A 1-year follow up targeting major adverse cardiovascular events (MACE) was performed.
Results: Group A had more females (38.7 vs 21.1 vs 24.4% p<0.01), patients were more admitted for unstable angina (37.3 vs 14.9 vs 17.9% p<0.01) and had a higher left ventricular ejection fraction (LVEF). Group B were more on previous statin therapy, had more often an admission for ST elevation acute myocardial infarction (17.3 vs 51.7 vs 42.4% p<0.001) and higher peak levels of cardiac biomarkers. Group C were older and had more frequently a previous history of coronary disease. Group C patients had a worse in-hospital mortality (1.8 vs 1.2 vs 7.5% p<0.01) and morbidity. The MACE free survival rate was significantly lower for group C (92.9% vs. 92.9% vs. 78.2%; log rank p<0.001). In a multivariate Cox regression analysis, incomplete revascularization remained an independent predictor of MACE at 1 year (HR 2.74, CI 1.50 – 4.94), in a model that included, age, gender, LVEF, diabetes, coronary anatomy, and admission diagnosis.
Conclusion: Our data strongly support the use of an aggressive invasive strategy in ACS, aimed at achieving full revascularization, as these patients had the same medium term prognosis as those with normal coronary angiogram.