Abstract
BACKGROUND: Randomized clinical trials have found that early invasive strategies reduce mortality, myocardial infarction (MI), and rehospitalization compared with a conservative invasive approach in acute coronary syndromes (ACSs), but the effectiveness of such strategies in real-world settings is unknown.
OBJECTIVE: To investigate adverse cardiovascular outcomes of an early versus a conservative invasive strategy in a national cohort of patients with ACSs.
DESIGN: Retrospective cohort study.
SETTING: Administrative health care data on hospitalizations, procedures, and outcomes abstracted from the Danish national registries and covering all acute invasive procedures in patients presenting with an ACS.
PATIENTS: 19 704 propensity score-matched patients hospitalized with a first ACS between 1 January 2005 and 31 December 2011.
MEASUREMENTS: Risk for cardiac death or rehospitalization for MI within 60 days of hospitalization.
RESULTS: Compared with a conservative approach, early invasive strategies were associated with a lower risk for cardiac death (cumulative incidence, 5.9% vs. 7.6%; adjusted hazard ratio [HR], 0.75 [95% CI, 0.66 to 0.84]; P < 0.001). Similar results were found for rehospitalization for MI (cumulative incidence, 3.4% vs. 5.0%; adjusted odds ratio, 0.67 [CI, 0.58 to 0.77]; P < 0.001) and all-cause death (cumulative incidence, 7.3% vs. 10.6%; adjusted HR, 0.65 [CI, 0.59 to 0.72]; P < 0.001).
LIMITATION: Potential residual confounding due to lack of core clinical variables.
CONCLUSION: In this real-world cohort of patients with a first hospitalization for an ACS, the use of an early invasive treatment strategy was associated with a lower risk for cardiac death and rehospitalization for MI compared with a conservative invasive approach.
PRIMARY FUNDING SOURCE: Department of Cardiology, University Hospital Gentofte.
Originalsprog | Engelsk |
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Tidsskrift | Annals of Internal Medicine |
Vol/bind | 163 |
Udgave nummer | 10 |
Sider (fra-til) | 737-46 |
Antal sider | 10 |
ISSN | 0003-4819 |
DOI | |
Status | Udgivet - 17 nov. 2015 |