[Six-month outcomes and prediction of mortality in 458 patients with acute coronary syndromes without persistent ST segment elevation assigned to early invasive strategy].

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.