[An invasive strategy in non-ST-segment elevation acute coronary syndromes. From large trials to the real world]

We report the impact on prognosis of an invasive strategy used at our center for non-ST-segment elevation acute coronary syndrome.

We analyzed 504 consecutive patients with typical chest pain, electrocardiographic changes or increased troponin I serum values, who were divided into 2 cohorts: a) conservative group, 272 patients admitted between October 2001 and September 2002 and managed with a conservative strategy, and b) invasive group, 232 patients admitted between October 2002 and September 2003 for whom an invasive strategy was recommended. We recorded major events (death or reinfarction) and minor events (readmission or need for postdischarge revascularization) within a 12-week follow-up period.

In the invasive group in-hospital angioplasty (21% vs 35%, P<.0001) and in-hospital revascularization (33% vs 48%, P=.001) increased. There were no significant differences between the conservative and the invasive group regarding major events (17% vs 15%). The invasive group was associated with a reduction in minor events (17% vs 9%, P=.01). The incidence of any event was reduced (28% vs 20%, P=.04). In the multivariate analysis for the whole group (n=504) the invasive strategy significantly reduced minor events (hazard ratio 0.5 [0.3-0.8], P=.008) and any event (hazard ratio 0.5 [0.3-0.8], P=.005), but not major events (hazard ratio 0.6 [0.4-1.1], P=.09).

The results observed in recent randomized clinical trials regarding the use of an invasive strategy were confirmed in the real world. In the short term, the benefits seem to be confined to a reduction in minor events, i.e., fewer readmissions and less need for postdischarge revascularization.