Characteristics and outcomes of medically managed patients with non-ST-segment elevation acute coronary syndromes: Insights from the multinational EPICOR Asia study. (15th September 2017)

• Record Type: Journal Article
• Authors: Chin, Chee Tang; Ong, Tiong K.; Krittayaphong, Rungroj; Lee, Stephen W.-L.; Sawhney, Jitendra P.S.; Kim, Hyo-Soo; Garcia, Angeles Alonso; Bueno, Héctor; Pocock, Stuart J.; Nhan, Vo T.; Vega, Ana; Hayashi, Nobuya; Huo, Yong
• Is Part Of: International journal of cardiology. Volume 243(2017)
• Page Start: 15
• Page End: 20
• Publication Date: 2017-09-15
• Subjects: Acute coronary syndromes -- Asia -- Medical management -- Long-term outcomes; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.04.059
• Languages: English
• ISSNs: 0167-5273

Abstract

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 2 years. 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 2 years 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.