Early vs. Conservative Invasive Treatment Strategy in ACS

Study Questions:

What are the adverse cardiovascular outcomes of an early versus conservative invasive strategy in a national cohort of patients with acute coronary syndrome (ACS)?

Methods:

This was a retrospective cohort study. Administrative health care data on hospitalizations, procedures, and outcomes abstracted from the Danish national registries and covering all acute invasive procedures in patients presenting with an ACS were utilized. A total of 19,704 propensity score–matched patients hospitalized with a first ACS between January 1, 2005 and December 31, 2011 were studied. Risk for cardiac death or rehospitalization for myocardial infarction (MI) within 60 days of hospitalization was the primary endpoint. All-cause death was included as a secondary outcome measure.

Results:

Compared with a conservative approach, early invasive strategies were associated with a lower risk for cardiac death (cumulative incidence, 5.9% vs. 7.6%; adjusted hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.66-0.84; p < 0.001). Similar results were found for rehospitalization for MI (cumulative incidence, 3.4% vs. 5.0%; adjusted odds ratio, 0.67; 95% CI, 0.58-0.77; p < 0.001) and all-cause death (cumulative incidence, 7.3% vs. 10.6%; adjusted HR, 0.65; 95% CI, 0.59-0.72; p < 0.001).

Conclusions:

The authors concluded that in this real-world cohort of patients with a first hospitalization for an ACS, the use of an early invasive treatment strategy was associated with a lower risk for cardiac death and rehospitalization for MI compared with a conservative invasive approach.

Perspective:

This study used national administrative health data to evaluate the effect of early invasive strategies in patients with ACS and reports that compared with a conservative invasive approach, an early invasive approach was associated with a decreased risk for adverse cardiac events, including cardiac death, in patients hospitalized with a first ACS. Despite the limitations of lacking core clinical variables, overall study data support the current non-ST-elevation MI guidelines, which recommend a risk-stratified approach and recommend that ACS patients at intermediate to high risk have early diagnostic coronary angiography within 24-72 hours.

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Acute Coronary Syndrome, Coronary Angiography, Hospitalization, Mortality, Myocardial Infarction, Outcome Assessment (Health Care), Risk


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