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Analysis of the invasive strategy decision in patients with acute coronary syndrome without ST-segment elevation in a real-world setting.
De Abreu, Maximiliano; Mariani, Javier A; Silberstein, Alejandro; Guridi, Cristian; Hecht, Gabriela; Gagliardi, Juan A; Doval, Hernán C; Tajer, Carlos D.
Afiliação
  • De Abreu M; Grupo de Estudio, Docencia e Investigación Clínica, Investigadores del Registro Epi-Cardio, Buenos Aires, Argentina. Electronic address: maxideabreu@gmail.com.
  • Mariani JA; Grupo de Estudio, Docencia e Investigación Clínica, Investigadores del Registro Epi-Cardio, Buenos Aires, Argentina.
  • Silberstein A; Grupo de Estudio, Docencia e Investigación Clínica, Investigadores del Registro Epi-Cardio, Buenos Aires, Argentina.
  • Guridi C; Grupo de Estudio, Docencia e Investigación Clínica, Investigadores del Registro Epi-Cardio, Buenos Aires, Argentina.
  • Hecht G; Grupo de Estudio, Docencia e Investigación Clínica, Investigadores del Registro Epi-Cardio, Buenos Aires, Argentina.
  • Gagliardi JA; Grupo de Estudio, Docencia e Investigación Clínica, Investigadores del Registro Epi-Cardio, Buenos Aires, Argentina.
  • Doval HC; Grupo de Estudio, Docencia e Investigación Clínica, Investigadores del Registro Epi-Cardio, Buenos Aires, Argentina.
  • Tajer CD; Grupo de Estudio, Docencia e Investigación Clínica, Investigadores del Registro Epi-Cardio, Buenos Aires, Argentina.
Am J Cardiol ; 113(12): 1956-61, 2014 Jun 15.
Article em En | MEDLINE | ID: mdl-24793674
Observational studies have reported a marked discrepancy between the risk estimated by scores and the use of an invasive strategy in patients with acute coronary syndromes. The objective is to describe the criteria used to decide an early invasive strategy and to determine the differences between those criteria and the thrombolysis in myocardial infarction risk score (TRS). Patients entered to the Epi-Cardio registry with a diagnosis of non-ST-elevation acute coronary syndrome were analyzed. A logistic regression model including variables associated with an early invasive strategy was developed and validated in 2 consecutive cohorts. The association between the TRS and the clinical decision model with an early invasive strategy was evaluated by receiver operating characteristic (ROC) curves. We included a total of 3,187 patients. In the derivation cohort, variables associated with an early invasive strategy were previous angioplasty (odds ratio [OR] 1.63), hypercholesterolemia (OR 1.36), ST changes (OR 1.49), elevated biomarkers (OR 1.42), catheterization laboratory availability (OR 1.7), recurrent angina (OR 3.45), age (OR 0.98), previous coronary bypass (OR 0.65), previous heart failure (OR 0.40), and heart rate at admission (OR 0.98). The areas under the ROC curves to predict invasive strategy were 0.55 for the TRS and 0.69 for the clinical decision model, p <0.0001. In the validation cohort, ROC areas were 0.58 and 0.70, respectively, p <0.0001. In conclusion, invasive strategy was guided by variables not completely included in risk scores. The clinical, evolutionary, and structural variables included in the model can explain, partially, the discordance existing between risk stratification and medical strategies.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Terapia Trombolítica / Mortalidade Hospitalar / Síndrome Coronariana Aguda Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Evaluation_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged País/Região como assunto: America do sul / Argentina Idioma: En Revista: Am J Cardiol Ano de publicação: 2014 Tipo de documento: Article País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Terapia Trombolítica / Mortalidade Hospitalar / Síndrome Coronariana Aguda Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Evaluation_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged País/Região como assunto: America do sul / Argentina Idioma: En Revista: Am J Cardiol Ano de publicação: 2014 Tipo de documento: Article País de publicação: Estados Unidos