Use of an invasive coronary strategy may be associated with improvements in survival following a non-ST-elevation myocardial infarction (NSTEMI), according to a study presented Aug. 30 during ESC Congress 2016 in Rome and simultaneously published in the Journal of the American Medical Association.

The study, led by Marlous Hall, PhD, looked at 389,057 patients with NSTEMI in 247 hospitals in England and Wales between 2003 and 2013. Results showed that unadjusted all-cause mortality rates at 180 days decreased from 10.8 percent to 7.6 percent. They explain that the findings weren’t changed when adjusting by baseline GRACE risk score, sex and socioeconomic status, comorbidities and pharmacological therapies. However, after adjusting by use of an invasive coronary strategy (coronary angiography, percutaneous coronary intervention and coronary artery bypass graft surgery) a relative decrease in mortality of 46.1 percent was shown.

The authors note that their findings “should not be interpreted to indicate that medical therapies have no role in management of NSTEMI.” They add that “in the cohort, aspirin, P2Y₁₂ inhibitors, beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins each had a significant association with improved survival.”

In a related editorial comment, Erin A. Bohula, MD, DPhil, and Elliott M. Antman, MD, MACC, note that “these findings represent a success story of ‘bench to bedside’ translation, with improvements in outcomes with risk-based provision of an invasive strategy in the backdrop of improving stent technologies and excellent medical therapy.” They go on to explain that these successes should be extended to low- and middle-income countries “where the resources are limited but the needs are the greatest.”

 

Keywords: ESC Congress, Adrenergic beta-Antagonists, American Medical Association, Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Aspirin, Comorbidity, Coronary Angiography, Coronary Artery Bypass, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Myocardial Infarction, Percutaneous Coronary Intervention, Social Class, Stents

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