AIMS: Acute coronary syndromes without ST-segment elevation (NSTEACS) represent an increasingly frequent cause of hospital admission. The BLITZ-2 study was planned to survey the epidemiology and management strategies of NSTEACS in the Italian cardiological network. METHODS AND RESULTS: The study included 1888 patients with NSTEACS in 275 hospitals in 3 weeks. At admission, almost 20% of patients showed clinical signs of heart failure, half showed ST-segment depression, and half showed any positive biochemical myocardial necrosis marker. Patients admitted to hospitals without CathLab (n=973) were older (P=0.0005) and with higher Killip class on admission (P<0.0001) when compared with those admitted to hospitals with CathLab (n=915). During index hospitalization, 76% of the patients initially admitted to hospitals with invasive capability underwent coronary angiography and 39% percutaneous coronary intervention when compared with 39 and 17.2% of those admitted to hospitals without CathLab (P<0.001). Overall, 30-day mortality was 2.4% (2.0% in patients with invasive capability vs. 2.9% in hospitals without CathLab, P=0.2). Cardiac ischaemic events at 30 days (recurrent MI, recurrent angina, and re-hospitalization for ACS) were significantly higher in the group of patients admitted to hospitals without CathLab (OR 1.71, 95% CI 1.24-2.35). However, after multivariable adjustment, only advanced age (OR 1.043, 95% CI 1.021-1.065, P<0.0001) and Killip class >1 (OR 1.633, 95% CI 1.020-2.614, P=0.04) resulted in independent predictors of death, in-hospital MI, and re-admission for ACS, whereas the absence of an on-site CathLab did not predict an adverse outcome (OR 1.104, 95% CI 0.734-1.660). CONCLUSION: According to this, the nationwide registry outcome is only marginally influenced by invasive procedures. Contemporary management of patients with NSTEACS in Italy is primarily driven by resource availability.
AIMS: Acute coronary syndromes without ST-segment elevation (NSTEACS) represent an increasingly frequent cause of hospital admission. The BLITZ-2 study was planned to survey the epidemiology and management strategies of NSTEACS in the Italian cardiological network. METHODS AND RESULTS: The study included 1888 patients with NSTEACS in 275 hospitals in 3 weeks. At admission, almost 20% of patients showed clinical signs of heart failure, half showed ST-segment depression, and half showed any positive biochemical myocardial necrosis marker. Patients admitted to hospitals without CathLab (n=973) were older (P=0.0005) and with higher Killip class on admission (P<0.0001) when compared with those admitted to hospitals with CathLab (n=915). During index hospitalization, 76% of the patients initially admitted to hospitals with invasive capability underwent coronary angiography and 39% percutaneous coronary intervention when compared with 39 and 17.2% of those admitted to hospitals without CathLab (P<0.001). Overall, 30-day mortality was 2.4% (2.0% in patients with invasive capability vs. 2.9% in hospitals without CathLab, P=0.2). Cardiac ischaemic events at 30 days (recurrent MI, recurrent angina, and re-hospitalization for ACS) were significantly higher in the group of patients admitted to hospitals without CathLab (OR 1.71, 95% CI 1.24-2.35). However, after multivariable adjustment, only advanced age (OR 1.043, 95% CI 1.021-1.065, P<0.0001) and Killip class >1 (OR 1.633, 95% CI 1.020-2.614, P=0.04) resulted in independent predictors of death, in-hospital MI, and re-admission for ACS, whereas the absence of an on-site CathLab did not predict an adverse outcome (OR 1.104, 95% CI 0.734-1.660). CONCLUSION: According to this, the nationwide registry outcome is only marginally influenced by invasive procedures. Contemporary management of patients with NSTEACS in Italy is primarily driven by resource availability.
Authors: Gianni Casella; Giuseppe Di Pasquale; Luigi Oltrona Visconti; Maria Giovanna Pallotti; Donata Lucci; Pasquale Caldarola; Marino Scherillo; Aldo P Maggioni Journal: Eur Heart J Acute Cardiovasc Care Date: 2013-03
Authors: John P Vavalle; Renato D Lopes; Anita Y Chen; L Kristin Newby; Tracy Y Wang; Bimal R Shah; P Michael Ho; Stephen D Wiviott; Eric D Peterson; Matthew T Roe; Christopher B Granger Journal: Am J Med Date: 2012-08-22 Impact factor: 4.965
Authors: Marco Ambrosetti; Raffaele Griffo; Roberto Tramarin; Francesco Fattirolli; Pier Luigi Temporelli; Pompilio Faggiano; Stefania De Feo; Anna Rita Vestri; Francesco Giallauria; Cesare Greco Journal: Intern Emerg Med Date: 2013-10-22 Impact factor: 3.397
Authors: Leonardo De Luca; Zoran Olivari; Leonardo Bolognese; Donata Lucci; Lucio Gonzini; Antonio Di Chiara; Gianni Casella; Francesco Chiarella; Alessandro Boccanelli; Giuseppe Di Pasquale; Francesco M Bovenzi; Stefano Savonitto Journal: Open Heart Date: 2014-12-13
Authors: Petr Widimsky; William Wijns; Jean Fajadet; Mark de Belder; Jiri Knot; Lars Aaberge; George Andrikopoulos; Jose Antonio Baz; Amadeo Betriu; Marc Claeys; Nicholas Danchin; Slaveyko Djambazov; Paul Erne; Juha Hartikainen; Kurt Huber; Petr Kala; Milka Klinceva; Steen Dalby Kristensen; Peter Ludman; Josephina Mauri Ferre; Bela Merkely; Davor Milicic; Joao Morais; Marko Noc; Grzegorz Opolski; Miodrag Ostojic; Dragana Radovanovic; Stefano De Servi; Ulf Stenestrand; Martin Studencan; Marco Tubaro; Zorana Vasiljevic; Franz Weidinger; Adam Witkowski; Uwe Zeymer Journal: Eur Heart J Date: 2009-11-19 Impact factor: 29.983