Search

Unlabelled: We aimed at assessing the frequency of death, myocardial infarction, unstable angina, repeat revascularization, cardiovascular hospitalisation during 12 months in patients assigned to early invasive strategy., Material and Method: We analysed 658 consecutive patients with acute coronary syndrome (ACS) without ST-segment elevation hospitalized between January 2000 and February 2003. Patients had to fulfill the following criteria: 1) rest angina within 24 hours prior to admission, 2) at least one of the following: ST-segment depression (> or = 0,05 mV), transient (< 20 min) ST-segment elevation (> or = 0,05 mV), T-wave inversion (> or = 1 mV) in at least 2 contiguous leads, positive serum cardiac markers., Results: All patients underwent coronary angiography followed by PCI (percutaneous coronary interventions) in 71.8% of patients. 18.2% were assigned to CABG (coronary artery bypass graft) and 8.7% of patients were treated conservatively. 1.3% of patients underwent PCI followed by an elective CABG surgery. In-hospital mortality rate was.,3%. 3.3% patients died after hospital discharge. The frequency of myocardial infarction, unstable angina and repeat PCI at 12 months was 2.1%, 16.8% and 11.5% respectively. The rate of cardiovascular hospitalisation was 15.6%. Multivariate analysis identified two independent predictors ofdeath: diabetes mellitus (OR: 7.02, 95% CI: 1.5-13.8, p = 0.03) and heart failure (OR: 12.6, 95% CI: 2.86-16.6 p = 0.005)., Conclusions: Early invasive strategy in analysed group yields good long-term outcomes with low rate of adverse ischemic events. Independent predictors of deaths were diabetes mellitus and heart failure.

Background: Early invasive strategy is one of alternative methods for management of acute coronary syndromes (ACS) without persistent ST-segment elevation., Hypothesis: The aim of the study was analysis of clinical characteristics, in-hospital outcome and factors of in-hospital mortality., Methods: The study group comprised 853 patients who were defined as high-risk, based on resting pain episodes within previous 24 hours, changes of ST-T segment in ECG, and elevated serum cardiac markers. All patients underwent coronary angiography followed by PCI (percutaneous coronary interventions) in 73.1% of patients. 16.7% were assigned to CABG (coronary artery bypass graft), 1.6% of patients underwent PCI and CABG and 8.6% of patients were treated conservatively., Results: Overall in-hospital mortality was 3%; 1.4% in the PCI group, 8.4% in the CABG group and 6.8% in conservatively treated patients. The independent risk factors of in-hospital deaths were: Braunwald's IIIC class angina (OR 7.8; 95%CI 3.6-12.37 p=0.004), recurrent angina after revascularization (OR 13.04; 95%CI 7.62-29.23 p=0.002), congestive heart failure (OR 11.45; 95%CI 8.01-18,38 p=0.00001) and evolving myocardial infarction with ST-segment elevation (OR 12.77; 95%CI 8.35-27.35 p=0.0001). Stent implantation was associated with decreased risk of in-hospital death (OR 0.12; 95%CI 0.07-0.41; p=0.003)., Conclusions: Early invasive strategy in patients with ACS without ST-segment elevation is efficacious method of treatment. Independent predictors of in-hospital deaths are: Braunwald's IIIC class angina, congestive heart failure, recurrent angina after revascularization, myocardial infarction complicating hospital course. Stent implantation improves in-hospital prognosis.

Background: Utilization of early invasive strategy for patients with acute coronary syndromes (ACS) without persistent ST-segment elevation remains controversial. In this study we characterized a group of high-risk patients who underwent early invasive assessment and treatment., Methods: We analysed 458 consecutive pts who fulfilled following criteria: (1) rest angina within 24 hours prior to admission, (2) at least one of the following: ST-segment depression (> or = 0.05 mV), transient (> or =20 min) ST-segment elevation (> or = 0.05 mV), T-wave inversion (> or =1 mV) in at least 2 contiguous leads, positive serum cardiac markers. All patients were diagnosed invasively with subsequent revascularization if appropriate. Analysis of long-term survival and occurrence of major adverse cardiovascular events requiring hospitalization (MACE) was performed., Results: Baseline characteristics of the pts: Age: 61.5 +/- 10 years, males: 67.3%, diabetes: 19.6%, hypertension: 72.9%, smokers: 39.5%, hyperlipidemia: 78.6%, previous myocardial infarction: 50.4%, previous CABG 6.5%, previous PCI 14.4%. PCI was performed in 71.8% of pts, 18.2% underwent CABG, 1.3% had combined PCI and elective CABG and 8.7% of pts were treated conservatively. In-hospital and overall mortality was 3.3% and 4.8% respectively. MACE were observed in 20.3% of pts. Multivariate analysis identified two independent predictors of death: diabetes mellitus (OR: 6.01, 95% CI: 1.1-13.2, p = 0.04) and heart failure (OR: 11.6, 95% CI: 2.56-15.6, p = 0.005) and three predictors of combined endpoint (death, non-fatal myocardial infarction, repeat revascularization): male sex (OR: 3.33, 95% CI: 1.30-8.55, p = 0.01), previous MI (OR: 2.32, 95% CI: 1.07-5.03, p = 0.03) and PCI treatment of acute coronary syndrome (OR: 3.11, 95% CI: 1.39-6.98, p = 0.006)., Conclusions: Early invasive strategy in high-risk ACS patients yields good long-term results with low mortality rate, especially during in-hospital observation. Diabetes mellitus and heart failure were independently associated with increased mortality rate, whereas male sex, previous MI and PCI during index hospitalization predicted major adverse cardiovascular events in 6-month follow-up.

Acute coronary syndromes (ACS) without persistent ST-segment elevation are the main cause of hospitalization, morbidity and mortality. The objective of this study was to compare clinical and angiographic parameters as well as in-hospital results of treating 307 consecutive patients with ACS without persistent ST-segment elevation with either PCI or CABG. Inclusion criteria were: rest angina within the last 24 hours, ST-segment depression (> 0.5 mm), T-wave inversion (> 1 mm) in at least two leads, positive serum cardiac markers. PCI was performed in 75.9% of patients and 24.1% of patients underwent CABG. Both groups did not differ as to age, sex, history of diabetes, arterial hypertension, heart failure, smoking and ejection fraction. Positive troponin was significantly more frequent in the PCI group. 51% of PCI patients and 80% of CABG patients had complete revascularization (p = 0.00001). Independent predictors of in-hospital death in the CABG group were: inability to determine culprit vessel during coronary angiography due to lesions' severity (OR 13.65; 95% CI 9.40-15.20; p = 0.007) and heart failure (OR 15.58; 95% CI 12.29-18.01; p = 0.003). In the PCI group these independent predictors were: Braunwald's IIIC unstable angina (OR 5.48; 95% CI 3.10-7.17; p = 0.04) and diabetes (OR 2.22; 95% CI 1.07-3.90; p = 0.003). In-hospital mortality rate was significantly higher in the CABG group (8.1% vs 1.7% p < 0.01). Patients with multivessel coronary artery disease and ACS without ST-segment elevation treated with PCI have better in-hospital outcome than patients assigned to CABG, but the rate of complete revascularization is lower.

Background: Percutaneous coronary interventions (PCI) and coronary artery bypass grafting (CABG) are well established revascularization methods in stable coronary artery disease and in acute coronary syndromes (ACS) as well., Methods: We analyzed 361 patients hospitalized with clinical diagnosis of ACS without persistent ST segment elevation. Patients had an episode of rest angina in the previous 24 hours and had to fulfil at least one of the criteria: 1. ST segment depression (>0.5 mm), 2. transient ST segment elevation or T-wave inversion (> 1 mm), 3. positive serum cardiac markers. We aimed at assessing the frequency of adverse events (death, myocardial infarction, repeat revascularization unstable angina, cardiovascular hospitalization) during follow-up and determining the predictors of 12-month mortality., Results: In the analyzed group 284 patients (78.7%) underwent PCI and 77 patients (21.3%) were assigned to CABG. Overall mortality in the PCI group and in the CABG group was 3.5% and 9.1% respectively (p=0.04). In-hospital mortality rate was higher in the CABG group (7.8% vs. 1.8% p<0.02). After discharge mortality rate was 1.8% in the PCI and 1.4% in the CABG group (NS). The rate of MI during follow-up was similar in both groups. Fewer CABG patients had episodes of unstable angina, MI, repeat revascularization and cardiovascular hospitalisation. Independent predictors of death in the PCI group were: post-procedure recurrent angina (OR 2.40; 95%CI 1.20-4.19; p=0.03) and heart failure (OR 4.75; 95%CI 1.80-12.70; p=0.01), while in the CABG group these predictors were: inability to determine culprit vessel (OR 4,29; 95%CI 2.20-15.6; p=0.02) and heart failure (OR 7.70; 95%CI 3.74-21.49; p=0.05)., Conclusions: We observed a higher overall mortality rate at one year in CABG patients, whereas PCI patients had a higher rate of unstable angina, repeat revascularization and cardiovascular hospitalization during 12-month follow-up.