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RESEARCH PRODUCT

Invasive treatment of NSTEMI patients in German Chest Pain Units - Evidence for a treatment paradox.

Frank P. SchmidtClaus SchmittMatthias HochadelEvangelos GiannitsisHarald DariusLars S. MaierClaus SchmittGerd HeuschThomas VoigtländerHarald MudraTommaso GoriJochen SengesThomas Münzel

subject

MaleAcute coronary syndromemedicine.medical_specialtyChest Painmedicine.medical_treatmentMedizin030204 cardiovascular system & hematologyChest painRevascularizationLower riskAnginaCohort Studies03 medical and health sciences0302 clinical medicinePercutaneous Coronary InterventionInternal medicineGermanyMedicineHumans030212 general & internal medicineMyocardial infarctioncardiovascular diseasesddc:610Hospital MortalityProspective StudiesRegistriesNon-ST Elevated Myocardial InfarctionAgedAged 80 and overEvidence-Based Medicinebusiness.industryPercutaneous coronary interventionMiddle Agedmedicine.diseaseTreatment OutcomeConventional PCICardiologyFemalemedicine.symptomCardiology and Cardiovascular MedicinebusinessFollow-Up Studies

description

Background: Patients with non ST-segment elevation myocardial infarction (NSTEMI) represent the largest fraction of patients with acute coronary syndrome in German Chest Pain units. Recent evidence on early vs. selective percutaneous coronary intervention (PCI) is ambiguous with respect to effects on mortality, myocardial infarction (MI) and recurrent angina. With the present study we sought to investigate the prognostic impact of PCI and its timing in German Chest Pain Unit (CPU) NSTEMI patients. Methods and results: Data from 1549 patients whose leading diagnosis was NSTEMI were retrieved from the German CPU registry for the interval between 3/2010 and 3/2014. Follow-up was available at median of 167 days after discharge. The patients were grouped into a higher (Group A) and lower risk group (Group B) according to GRACE score and additional criteria on admission. Group A had higher Killip classes, higher BNP levels, reduced EF and significant more triple vessel disease (p < 0.001). Surprisingly, patients in group A less frequently received early diagnostic catheterization and PCI. While conservative management did not affect prognosis in Group B, higher-risk CPU-NSTEMI patients without PCI had a significantly worse survival. Conclusions: The present results reveal a substantial treatment gap in higher-risk NSTEMI patients in German Chest Pain Units. This treatment paradox may worsen prognosis in patients who could derive the largest benefit from early revascularization.

yearjournalcountryeditionlanguage
2018-03-01International journal of cardiology
10.1016/j.ijcard.2017.11.018https://pubmed.ncbi.nlm.nih.gov/29936048