Invasive Approaches in the Management of Cocaine-Associated Non–ST-Segment Elevation Myocardial Infarction
| Autor: | Samarthkumar Thakkar, Rahul Jaswaney, Mohammed Najeeb Osman, Byomesh Tripathi, Nirav Arora, Brian D. Hoit, Richard Josephson, Sidakpal S. Panaich, Chinmay Jani, Mohini Patel, David A. Zidar, Mehdi H. Shishehbor, Shilpkumar Arora, Zachary Zuzek |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment Hazard ratio Percutaneous coronary intervention Retrospective cohort study 030204 cardiovascular system & hematology medicine.disease Revascularization 03 medical and health sciences 0302 clinical medicine Internal medicine Conventional PCI medicine Cardiology ST segment 030212 general & internal medicine Myocardial infarction Cardiology and Cardiovascular Medicine business Mace |
| Zdroj: | JACC: Cardiovascular Interventions. 14:623-636 |
| ISSN: | 1936-8798 |
| DOI: | 10.1016/j.jcin.2021.01.005 |
| Popis: | Objectives The aim of this study was to determine the impact of invasive approaches and revascularization in patients with cocaine-associated non–ST-segment elevation myocardial infarction (NSTEMI). Background The role of invasive approaches in cocaine-associated NSTEMI is uncertain. Methods This retrospective cohort study identified 3,735 patients with NSTEMI and history of cocaine use from the Nationwide Readmissions Database from 2016 to 2017. Invasive approaches were defined as coronary angiography, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). Revascularization was defined as PCI and CABG. The primary efficacy outcome was major adverse cardiac events (MACE), and the primary safety outcome was emergent revascularization. Nonadherence was identified using appropriate International Classification of Diseases-Tenth Revision codes. Two propensity-matched cohorts were generated (noninvasive vs. invasive and noninvasive vs. revascularization) through multivariate logistic regression. Results In the propensity score–matched cohorts, an invasive approach (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.56 to 0.92; p = 0.008) and revascularization (HR: 0.54; 95% CI: 0.40 to 0.73; p Conclusions Invasive approaches and revascularization for cocaine-associated NSTEMI are associated with lower morbidity. A history of medical nonadherence was not associated with a difference in morbidity but was associated with an increased risk for emergent revascularization with PCI. |
| Databáze: | OpenAIRE |
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