Abstract 12626: Predictors of Initial Revascularization versus Medical Therapy in Patients With Non-ST Segment Elevation Acute Coronary Syndrome Undergoing an Invasive Strategy
Background: Although an invasive strategy is a Class I clinical practice guideline for non-ST-segment elevation acute coronary syndromes (NSTE-ACS), there is wide variation in the proportion of such patients who undergo revascularization despite early angiography. We sought to identify the predictors of early revascularization versus medical therapy alone in NSTE-ACS patients undergoing an invasive strategy and contrast their clinical outcomes.
Methods: We assessed revascularization status (PCI or CABG within 7 days of the index angiogram) in all NSTE-ACS patients treated with an invasive strategy at 18 hospitals in Ontario, Canada from October 1st 2008 to October 31st, 2013, using the Cardiac Care Network registry. Follow-up was until December 31st, 2014. The primary outcome was death. Multivariable, hierarchical logistic models were used to identify predictors of revascularization. Multivariable Cox models with treatment strategy as a 3-level time-varying covariate were developed to understand the relationship between revascularization status and clinical outcomes.
Results: We identified 50,302 NSTE-ACS patients of whom 34,288 (68.2%) underwent early revascularization (28,011 by PCI; 6,277 by CABG). There was a twofold variation in revascularization rates (Figure). High risk based on the TIMI/GRACE score was a significant predictor of revascularization (OR 1.26; 95% CI 1.18-1.35) as was having the angiogram by an interventional cardiologist (OR 1.76, 95% CI 1.57-1.98) or at a diagnostic only hospital (OR 1.22, 95% CI 1.01-1.48). Compared to patients treated medically, those who were revascularized with either PCI (HR 0.64, 95% CI 0.60-0.69) or CABG (HR 0.53, 95% CI 0.47-0.60) had improved survival.
Conclusions: While more than 2/3rds of NSTE-ACS patients who underwent an early invasive approach did receive revascularization, there was wide variation. Those who underwent revascularization had significantly improved clinical outcomes.
Author Disclosures: H.C. Wijeysundera: None. M.S. Sidhu: None. M.C. Bennell: None. F. Qiu: None. M. Knudston: None. J.V. Tu: None. D.T. Ko: None. W.E. Boden: None.
- © 2015 by American Heart Association, Inc.