Schmidt, Frank P. and Schmitt, Claus and Hochadel, Matthias and Giannitsis, Evangelos and Darius, Harald and Maier, Lars S. and Schmitt, Claus and Heusch, Gerd and Voigtlaender, Thomas and Mudra, Harald and Gori, Tommaso and Senges, Jochen and Muenzel, Thomas (2018) Invasive treatment of NSTEMI patients in German Chest Pain Units - Evidence for a treatment paradox. INTERNATIONAL JOURNAL OF CARDIOLOGY, 255. pp. 15-19. ISSN 0167-5273, 1874-1754
Full text not available from this repository. (Request a copy)Abstract
Background: Patients with non ST-segment elevation myocardial infarction (NSTEMI) represent the largest fraction of patients with acute coronary syndrome in German Chest Pain units. Recent evidence on early vs. selective percutaneous coronary intervention (PCI) is ambiguous with respect to effects on mortality, myocardial infarction (MI) and recurrent angina. With the present study we sought to investigate the prognostic impact of PCI and its timing in German Chest Pain Unit (CPU) NSTEMI patients. Methods and results: Data from 1549 patients whose leading diagnosis was NSTEMI were retrieved from the German CPU registry for the interval between 3/2010 and 3/2014. Follow-up was available at median of 167 days after discharge. The patients were grouped into a higher (Group A) and lower risk group (Group B) according to GRACE score and additional criteria on admission. Group A had higher Killip classes, higher BNP levels, reduced EF and significant more triple vessel disease (p < 0.001). Surprisingly, patients in group A less frequently received early diagnostic catheterization and PCI. While conservative management did not affect prognosis in Group B, higher-risk CPU-NSTEMI patients without PCI had a significantly worse survival. Conclusions: The present results reveal a substantial treatment gap in higher-risk NSTEMI patients in German Chest Pain Units. This treatment paradox may worsen prognosis in patients who could derive the largest benefit from early revascularization. (C) 2017 The Authors. Published by Elsevier Ireland Ltd.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | ACUTE CORONARY SYNDROMES; ST-SEGMENT ELEVATION; RANDOMIZED CONTROLLED-TRIAL; MYOCARDIAL-INFARCTION; UNSTABLE ANGINA; STRATEGY; INTERVENTION; METAANALYSIS; IMMEDIATE; WOMEN; Chest pain unit; NSTEMI; Coronary intervention; Prognosis |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 12 Mar 2020 09:02 |
| Last Modified: | 12 Mar 2020 09:02 |
| URI: | https://pred.uni-regensburg.de/id/eprint/14892 |
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