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Characteristics and outcomes of medically managed patients with non-ST-segment elevation acute coronary syndromes: Insights from the multinational EPICOR Asia study.
Int J Cardiol. 2017 Sep 15; 243:15-20.IJ

Abstract

BACKGROUND

Many patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) are medically managed without coronary revascularization. The reasons vary and may impact prognosis.

METHODS

EPICOR Asia (NCT01361386) is a prospective study of hospital survivors post-ACS enrolled in 218 hospitals from 8 countries/regions in Asia (06/2011-05/2012). All medically managed NSTE-ACS patients were classified into 3 groups: 1) no coronary angiography (CAG-); 2) non-significant coronary artery disease (CAD) on angiogram (CAG+ CAD-); and 3) significant CAD (CAG+ CAD+). We compared baseline differences between patients medically managed and patients undergoing revascularization, and also between the medically managed groups. Adverse events were reported and compared up to 2years.

RESULTS

Of 6163 NSTE-ACS patients, 2272 (37%) were medically managed, with 1339 (59%), 254 (11%), and 679 (30%) in the CAG-, CAG+ CAD-, and CAG+ CAD+ groups, respectively. There were marked differences in the proportion of medically managed patients among the 8 countries/regions (13-81%). Medically managed patients had higher mortality at 2years compared with revascularization (8.7% vs. 3.0%, p<0.001). Among medically managed patients, CAG- patients were older, more likely to have pre-existing cardiovascular disease, and had the highest 2-year mortality (10.5% vs. 4.3% [CAG+ CAD-] and 6.6% [CAG+ CAD+], p<0.001). Mortality differences persisted after adjusting for other patient risk factors.

CONCLUSIONS

Medically managed NSTE-ACS patients are a heterogeneous group with different risk stratification and variable prognosis. Identification of reasons underlying different management strategies, and key factors adversely influencing long-term prognosis, may improve outcomes.

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Authors+Show Affiliations

Chin CT
National Heart Centre Singapore, Singapore. Electronic address: chin.chee.tang@singhealth.com.sg.
Ong TK
Sarawak General Hospital, Kuching, Malaysia.
Krittayaphong R
Siriraj Hospital, Bangkok, Thailand.
Lee SW
Queen Mary Hospital, Hong Kong, SAR, China.
Sawhney JPS
Sir Ganga Ram Hospital, New Delhi, India.
Kim HS
Seoul National University Hospital, Seoul, Republic of Korea.
Garcia AA
Cardiovascular Science Research Centre, St George's University of London, UK.
Bueno H
Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Instituto de investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Spain; Universidad Complutense de Madrid, Spain.
Pocock SJ
London School of Hygiene and Tropical Medicine, London, UK.
Nhan VT
Cho Ray Hospital, Ho Chi Minh City, Vietnam.
Vega A
AstraZeneca, Madrid, Spain.
Hayashi N
AstraZeneca, Osaka, Japan.
Huo Y
Peking University First Hospital, Beijing, China.

MeSH

Acute Coronary SyndromeAgedAsiaDisease ManagementFemaleFollow-Up StudiesHumansInternationalityMaleMiddle AgedNon-ST Elevated Myocardial InfarctionProspective StudiesRisk FactorsTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28747021

Citation

Chin, Chee Tang, et al. "Characteristics and Outcomes of Medically Managed Patients With non-ST-segment Elevation Acute Coronary Syndromes: Insights From the Multinational EPICOR Asia Study." International Journal of Cardiology, vol. 243, 2017, pp. 15-20.
Chin CT, Ong TK, Krittayaphong R, et al. Characteristics and outcomes of medically managed patients with non-ST-segment elevation acute coronary syndromes: Insights from the multinational EPICOR Asia study. Int J Cardiol. 2017;243:15-20.
Chin, C. T., Ong, T. K., Krittayaphong, R., Lee, S. W., Sawhney, J. P. S., Kim, H. S., Garcia, A. A., Bueno, H., Pocock, S. J., Nhan, V. T., Vega, A., Hayashi, N., & Huo, Y. (2017). Characteristics and outcomes of medically managed patients with non-ST-segment elevation acute coronary syndromes: Insights from the multinational EPICOR Asia study. International Journal of Cardiology, 243, 15-20. https://doi.org/10.1016/j.ijcard.2017.04.059
Chin CT, et al. Characteristics and Outcomes of Medically Managed Patients With non-ST-segment Elevation Acute Coronary Syndromes: Insights From the Multinational EPICOR Asia Study. Int J Cardiol. 2017 Sep 15;243:15-20. PubMed PMID: 28747021.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characteristics and outcomes of medically managed patients with non-ST-segment elevation acute coronary syndromes: Insights from the multinational EPICOR Asia study. AU - Chin,Chee Tang, AU - Ong,Tiong K, AU - Krittayaphong,Rungroj, AU - Lee,Stephen W-L, AU - Sawhney,Jitendra P S, AU - Kim,Hyo-Soo, AU - Garcia,Angeles Alonso, AU - Bueno,Héctor, AU - Pocock,Stuart J, AU - Nhan,Vo T, AU - Vega,Ana, AU - Hayashi,Nobuya, AU - Huo,Yong, PY - 2016/10/27/received PY - 2017/03/15/revised PY - 2017/04/19/accepted PY - 2017/7/28/entrez PY - 2017/7/28/pubmed PY - 2018/4/19/medline KW - Acute coronary syndromes KW - Asia KW - Long-term outcomes KW - Medical management SP - 15 EP - 20 JF - International journal of cardiology JO - Int J Cardiol VL - 243 N2 - BACKGROUND: Many patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) are medically managed without coronary revascularization. The reasons vary and may impact prognosis. METHODS: EPICOR Asia (NCT01361386) is a prospective study of hospital survivors post-ACS enrolled in 218 hospitals from 8 countries/regions in Asia (06/2011-05/2012). All medically managed NSTE-ACS patients were classified into 3 groups: 1) no coronary angiography (CAG-); 2) non-significant coronary artery disease (CAD) on angiogram (CAG+ CAD-); and 3) significant CAD (CAG+ CAD+). We compared baseline differences between patients medically managed and patients undergoing revascularization, and also between the medically managed groups. Adverse events were reported and compared up to 2years. RESULTS: Of 6163 NSTE-ACS patients, 2272 (37%) were medically managed, with 1339 (59%), 254 (11%), and 679 (30%) in the CAG-, CAG+ CAD-, and CAG+ CAD+ groups, respectively. There were marked differences in the proportion of medically managed patients among the 8 countries/regions (13-81%). Medically managed patients had higher mortality at 2years compared with revascularization (8.7% vs. 3.0%, p<0.001). Among medically managed patients, CAG- patients were older, more likely to have pre-existing cardiovascular disease, and had the highest 2-year mortality (10.5% vs. 4.3% [CAG+ CAD-] and 6.6% [CAG+ CAD+], p<0.001). Mortality differences persisted after adjusting for other patient risk factors. CONCLUSIONS: Medically managed NSTE-ACS patients are a heterogeneous group with different risk stratification and variable prognosis. Identification of reasons underlying different management strategies, and key factors adversely influencing long-term prognosis, may improve outcomes. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/28747021/Characteristics_and_outcomes_of_medically_managed_patients_with_non_ST_segment_elevation_acute_coronary_syndromes:_Insights_from_the_multinational_EPICOR_Asia_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(16)32776-0 DB - PRIME DP - Unbound Medicine ER -
Grapherence [↓4]

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