Conservatively managed patients with non-ST-segment elevation acute coronary syndrome are undertreated with indicated medicines.

Autor: Elena Candela, Francisco Marín, José Miguel Rivera-Caravaca, Nuria Vicente Ibarra, Luna Carrillo, María Asunción Esteve-Pastor, Teresa Lozano, Manuel Jesús Macías, Vicente Pernias, Miriam Sandín, Esteban Orenes-Piñero, Miriam Quintana-Giner, Ignacio Hortelano, Beatriz Villamía, Andrea Veliz, Mariano Valdés, Juan G Martínez-Martínez, Juan M Ruiz-Nodar
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Zdroj: PLoS ONE, Vol 13, Iss 11, p e0208069 (2018)
Druh dokumentu: article
ISSN: 1932-6203
DOI: 10.1371/journal.pone.0208069
Popis: Introduction and aimsPatients with non-ST-elevation acute coronary syndrome (NSTE-ACS) are often managed conservatively. Clinical practice guidelines recommend treating these patients with the same pharmacological drugs as those who receive invasive treatment. We analyze the use of new antiplatelet drugs (NADs) and other recommended treatments in people discharged following an NSTE-ACS according to the treatment strategy used, comparing the medium-term prognosis between groups.MethodsProspective observational multicenter registry study in 1717 patients discharged from hospital following an ACS; 1143 patients had experienced an NSTE-ACS. We analyzed groups receiving the following treatment: No cardiac catheterization (NO CATH): n = 134; 11.7%; Cardiac catheterization without revascularization (CATH-NO REVASC): n = 256; 22.4%; percutaneous coronary intervention (PCI): n = 629; 55.0%; and coronary artery bypass graft (CABG): n = 124; 10.8%. We assessed major adverse cardiovascular events (MACE), all-cause mortality, and hemorrhagic complications at one year.ResultsNO CATH was the oldest, had the most comorbidities, and was at the highest risk for ischemic and hemorrhagic events. Few patients who were not revascularized with PCI received NADs (NO CATH: 3.7%; CATH-NO REVASC: 10.6%; PCI: 43.2%; CABG: 3.2%; pConclusionsDespite current invasive management of NSTE-ACS, patients not receiving catheterization are at very high risk for under treatment with recommended drugs, including NADs. Their medium-term prognosis is poor, with high mortality. Patients treated with PCI receive better pharmacological management, with high use of NADs.
Databáze: Directory of Open Access Journals
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