1. Invasive management and late clinical outcomes in contemporary Australian management of acute coronary syndromes: observations from the ACACIA registry.
- Author
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Chew DP, Amerena JV, Coverdale SG, Rankin JM, Astley CM, Soman A, and Brieger DB
- Subjects
- Acute Coronary Syndrome classification, Acute Coronary Syndrome drug therapy, Adult, Aged, Aged, 80 and over, Antihypertensive Agents therapeutic use, Australia, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Platelet Aggregation Inhibitors therapeutic use, Prospective Studies, Registries, Acute Coronary Syndrome surgery, Coronary Angiography, Myocardial Infarction prevention & control, Myocardial Revascularization
- Abstract
Objective: To describe the impact of invasive management on 12-month survival among patients with suspected acute coronary syndrome (ACS) in Australia., Design and Setting: Prospective nationwide multicentre registry., Patients: Patients presenting to 24 metropolitan and 15 non-metropolitan hospitals with ST-segment-elevation myocardial infarction (STEMI), and high-risk and intermediate-risk non-ST-segment-elevation ACS (NSTEACS) between 1 November 2005 and 31 July 2007., Main Outcome Measures: Death, myocardial infarction (MI) or recurrent MI, revascularisation and stroke at 12 months., Results: Among 3402 patients originally enrolled, vital status at 12 months was available for 3393 (99.7%). Patients from non-metropolitan areas (810) constituted 23.9% of patients. Early invasive management was more commonly undertaken among patients with STEMI (STEMI, 89.7% v non-STEMI, 70.8% v unstable angina, 44.8% v stable angina, 35.8%; P<0.001). Factors most associated with receiving invasive management included admission with suspected STEMI or high-risk NSTEACS, being male and the hospital having an onsite cardiac surgical service. Overall mortality by 12 months among patients with STEMI, non-STEMI, unstable angina and stable angina was 8.0%, 10.5%, 3.3%, and 3.7% (P<0.001), respectively. After adjusting for a propensity model predicting early invasive management and other known confounders, early invasive management was associated with a 12-month mortality hazard ratio of 0.53 (95% CI, 0.34-0.84, P=0.007)., Conclusions: A substantial burden of late morbidity and mortality persists among patients with ACS within contemporary Australian clinical practice. Under-use of invasive management may be associated with an excess in 12-month mortality, suggesting the need for more use of invasive management among these patients.
- Published
- 2008
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