[The CRUSADE study, evaluation model of quality in percutaneous coronary intervention]
M Ruiz Bailén1, L Rucabado Aguilar, E Aguayo de Hoyos
1Unidad de Medicina Intensiva, Servicio de Cuidados Críticos y Urgencias, Hospital Universitario Médico Quirúrgico, Complejo Hospitalario de Jaén, Jaén, España. mrb1604@terra.es
Insights
Early invasive treatment for non-ST segment elevation acute coronary syndrome (NSTE-ACS) reduces mortality. However, this effective strategy is underutilized, primarily benefiting lower-risk patients.
Area of Science:
- Cardiology
- Clinical Research
- Health Services Research
Context:
- Clinical trial evidence and treatment guidelines do not guarantee optimal patient outcomes.
- Real-world population studies are essential for evaluating care quality and treatment effectiveness.
- Clinical registries provide valuable data for assessing adherence to guidelines and real-world outcomes.
Purpose:
- To evaluate the utilization, prognosis, and predictive factors of an early invasive strategy using percutaneous coronary intervention (PCI) in high-risk patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS).
- To compare the effectiveness of early invasive strategy versus medical treatment in a large patient cohort.
- To identify patient characteristics associated with the selection for early invasive treatment.
Summary:
- The CRUSADE study analyzed 17,926 patients with NSTE-ACS, finding that 44.8% received cardiac catheterization within 48 hours.
- Intrahospital mortality was significantly lower with the early invasive strategy (2.5%) compared to medical treatment (3.7%).
- Patients undergoing early PCI were a selected group, with factors like cardiology care, younger age, and absence of renal or heart failure predicting its use.
Impact:
- Despite demonstrating reduced mortality, the early invasive strategy for NSTE-ACS is not widely applied.
- The benefits of early PCI are primarily observed in selected subgroups with lower comorbidity and those under cardiology care.
- This highlights a gap between evidence-based recommendations and real-world clinical practice for acute coronary syndromes.
Abstract:
Improvement of care quality does not end with the publication of clinical trials that show clinical evidence of effectiveness or with its support by the different international therapeutic guides. This quality improvement requires evaluation in the real population. This can be done by analysis of clinical registries, that would evaluate adequate compliance of the clinical guides and their effectiveness in the real population. The CRUSADE study is a study that evaluates use, prognosis and factors of prediction, of invasive strategy by early percutaneous coronary intervention (PCI) (first 48 hours of the ischemic event) in high-risk patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). Of the 17,926 patients studied, 8037 (44.8%) underwent cardiac catheterism in the first 48 hours of the ischemic event. Intrahospital mortality of the invasive strategy was significantly less than medical treatment (2.5% versus 3.7%). The patients who underwent an early invasive strategy were a selected population, as the more solid independent prediction factors were associated to early invasive treatment: cardiology care, earlier age, absence of renal failure, absence of heart failure both previously or on arrival to the hospital and lower heart rate. Finally, it could be concluded that, in spite of the decrease of mortality achieved with the early invasive strategy, this would not done in most of the patients, being reserved for subgroups with lower comorbidity and for those seen by the cardiologists.
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