Abstract 13599: Medically Managed Patients With Non ST-Segment Elevation Acute Coronary Syndromes: Frequency, Subgroups and Outcomes. Insights From the Multinational EPICOR Study
Background: A large proportion of patients with NSTEACS are medically managed (MM) initially and show a marked mortality after discharge. The potential reasons for not receiving coronary revascularization (CR) are varied and may influence prognosis. The initial strategy of coronary angiography (CAG) and CR might be associated with different clinical profiles and outcomes, even among patients who are initially MM.
Methods: EPICOR (NCT01171404) is a prospective, observational cohort study of 10568 consecutive hospital survivors after an ACS, enrolled in 555 hospitals from 20 European and Latin American countries between 10/2010 and 03/2011. We compared baseline characteristics and 1-year mortality according to strategy used in-hospital (CR vs. no CR). MM patients without CAG and those with CAG, but either non-significant coronary artery disease (CAG+ CAD-) or significant CAD but no CR (CAG+ CAD+), were also compared.
Results: Of 5572 NSTEACS patients, 3285 underwent CR (59%), 1186 (21.3%) did not undergo CAG (CAG-) and 1101 (19.8%) underwent CAG but no CR (7.8% CAG+ CAD-; 12% CAG+ CAD+). There were significant differences in age, risk factors, comorbidities, type of hospital and region among the 3 no CR subgroups, CAG- patients being significantly older and sicker, more frequent in Latin America and in patients admitted to hospitals without cath lab. One-year mortality was 2.6% in patients with CR and 7.0% in those without (P<.0001). After adjustment for 12 prognostic factors, CR was associated with a significantly lower 1-year mortality risk (P<.001). Significant differences (P<.001) in unadjusted 1-year mortality were also found among MM patient subgroups (Figure).
Conclusions: MM NSTEACS patients are a subgroup of particular concern. However, this is a heterogeneous population with different clinical features and outcomes. More research is needed to clarify the causes of the different invasive and revascularization strategies and to improve their prognoses.
- © 2013 by American Heart Association, Inc.