Breuckmann, Frank and Hochadel, Matthias and Darius, Harald and Giannitsis, Evangelos and Muenzel, Thomas and Maier, Lars S. and Schmitt, Claus and Schumacher, Burghard and Heusch, Gerd and Voigtlaender, Thomas and Mudra, Harald and Senges, Jochen (2015) Guideline-adherence and perspectives in the acute management of unstable angina - Initial results from the German chest pain unit registry. JOURNAL OF CARDIOLOGY, 66 (1-2). pp. 108-113. ISSN 0914-5087, 1876-4738
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Background: We investigated the current management of unstable angina pectoris (UAP) in certified chest pain units (CPUs) in Germany and focused on the European Society of Cardiology (ESC) guideline-adherence in the timing of invasive strategies or choice of conservative treatment options. More specifically, we analyzed differences in clinical outcome with respect to guideline-adherence. Method: Prospective data from 1400 UAP patients were collected. Analyses of high-risk criteria with indication for invasive management and 3-month clinical outcome data were performed. Guideline-adherence was tested for a primarily conservative strategy as well as for percutaneous coronary intervention (PCI) within <24 and <72 h after admission. Results: Overall guideline-conforming management was performed in 38.2%. In UAP patients at risk, undertreatment caused by an insufficient consideration of risk criteria was obvious in 78%. Reciprocally, overtreatment in the absence of adequate risk markers was performed in 27%, whereas a guideline-conforming primarily conservative strategy was chosen in 73% of the low-risk patients. Together, the 3-month major adverse coronary and cerebrovascular events (MACCE) were low (3.6%). Nonetheless, guideline-conforming treatment was even associated with significantly lower MACCE rates (1.6% vs. 4.0%, p < 0.05). Conclusion: The data suggest an inadequate adherence to ESC guidelines in nearly two thirds of the patients, particularly in those patients at high to intermediate risk with secondary risk factors, emphasizing the need for further attention to consistent risk profiling in the CPU and its certification process. (c) 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | ACUTE CORONARY SYNDROMES; MYOCARDIAL-INFARCTION; INTERVENTION; CARE; REVASCULARIZATION; CARDIOLOGY; MORTALITY; STRATEGY; OUTCOMES; SOCIETY; Unstable angina; Chest pain unit; Guideline; Timing; Cardiovascular events |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 08 Jul 2019 07:30 |
| Last Modified: | 08 Jul 2019 07:30 |
| URI: | https://pred.uni-regensburg.de/id/eprint/5232 |
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