Frank P Schmidt1, Claus Schmitt2, Matthias Hochadel3, Evangelos Giannitsis4, Harald Darius5, Lars S Maier6, Claus Schmitt2, Gerd Heusch7, Thomas Voigtländer8, Harald Mudra9, Tommaso Gori10, Jochen Senges3, Thomas Münzel11. 1. Zentrum für Kardiologie, Kardiologie 1, Johannes Gutenberg-University Mainz, Mainz, Germany; Klinikum Mutterhaus der Borromäerinnen, Trier, Germany. 2. Clinic for Cardiology and Angiology, Municipal Hospital Karlsruhe, Karlsruhe, Germany. 3. Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany. 4. 3rd Department of Medicine, University Hospital Heidelberg, Heidelberg, Germany. 5. Department of Cardiology, Angiology and Intensive Care Medicine, Vivantes-Klinikum Neukölln, Berlin, Germany. 6. 2nd Department of Medicine, University Hospital of Regensburg, Regensburg, Germany. 7. Institute for Pathophysiology, West German Heart and Vascular Center University Duisburg-Essen, Essen, Germany. 8. CCB, Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany. 9. Department of Cardiology, Pneumology and Internal Intensive Care Medicine, Klinikum Neuperlach, Städtisches Klinikum München GmbH, Munich, Germany. 10. Zentrum für Kardiologie, Kardiologie 1, Johannes Gutenberg-University Mainz, Mainz, Germany; Deutsches Zentrum für Herz- Und Kreislaufforschung, Standort Rhein-Mainz, Germany. 11. Zentrum für Kardiologie, Kardiologie 1, Johannes Gutenberg-University Mainz, Mainz, Germany. Electronic address: tmuenzel@uni-mainz.de.
Abstract
BACKGROUND: Patients with non ST-segment elevation myocardial infarction (NSTEMI) represent the largest fraction of patients with acute coronary syndrome in German Chest Pain units. Recent evidence on early vs. selective percutaneous coronary intervention (PCI) is ambiguous with respect to effects on mortality, myocardial infarction (MI) and recurrent angina. With the present study we sought to investigate the prognostic impact of PCI and its timing in German Chest Pain Unit (CPU) NSTEMI patients. METHODS AND RESULTS: Data from 1549 patients whose leading diagnosis was NSTEMI were retrieved from the German CPU registry for the interval between 3/2010 and 3/2014. Follow-up was available at median of 167days after discharge. The patients were grouped into a higher (Group A) and lower risk group (Group B) according to GRACE score and additional criteria on admission. Group A had higher Killip classes, higher BNP levels, reduced EF and significant more triple vessel disease (p<0.001). Surprisingly, patients in group A less frequently received early diagnostic catheterization and PCI. While conservative management did not affect prognosis in Group B, higher-risk CPU-NSTEMI patients without PCI had a significantly worse survival. CONCLUSIONS: The present results reveal a substantial treatment gap in higher-risk NSTEMI patients in German Chest Pain Units. This treatment paradox may worsen prognosis in patients who could derive the largest benefit from early revascularization.
BACKGROUND:Patients with non ST-segment elevation myocardial infarction (NSTEMI) represent the largest fraction of patients with acute coronary syndrome in German Chest Pain units. Recent evidence on early vs. selective percutaneous coronary intervention (PCI) is ambiguous with respect to effects on mortality, myocardial infarction (MI) and recurrent angina. With the present study we sought to investigate the prognostic impact of PCI and its timing in German Chest Pain Unit (CPU) NSTEMI patients. METHODS AND RESULTS: Data from 1549 patients whose leading diagnosis was NSTEMI were retrieved from the German CPU registry for the interval between 3/2010 and 3/2014. Follow-up was available at median of 167days after discharge. The patients were grouped into a higher (Group A) and lower risk group (Group B) according to GRACE score and additional criteria on admission. Group A had higher Killip classes, higher BNP levels, reduced EF and significant more triple vessel disease (p<0.001). Surprisingly, patients in group A less frequently received early diagnostic catheterization and PCI. While conservative management did not affect prognosis in Group B, higher-risk CPU-NSTEMI patients without PCI had a significantly worse survival. CONCLUSIONS: The present results reveal a substantial treatment gap in higher-risk NSTEMI patients in German Chest Pain Units. This treatment paradox may worsen prognosis in patients who could derive the largest benefit from early revascularization.
Authors: Frank Breuckmann; Stephan Settelmeier; Tienush Rassaf; Felix Post; Winfried Haerer; Johann Bauersachs; Harald Mudra; Thomas Voigtländer; Jochen Senges; Thomas Münzel; Evangelos Giannitsis Journal: Herz Date: 2021-11-09 Impact factor: 1.740
Authors: N P G Hoedemaker; P Damman; H A Bosker; P W Danse; A H Liem; B Geerdes; H van Laarhoven; R J de Winter Journal: Neth Heart J Date: 2019-04 Impact factor: 2.380