DEPARTMENT OF CARDIOVASCULAR MEDICINE, SHAHEED RAJAIE CARDIOVASCULAR MEDICAL AND RESEARCH CENTER, TEHRAN, IRAN
Background: Unstable angina is emerging as a major public health problem worldwide. Two approaches - an early invasive strategy or a conservative strategy - are used for the management of non-ST elevation acute coronary syndrome (NSTE-ACS). An early invasive strategy involves the use of early coronary angiography and revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). A conservative strategy involves initial treatment with aggressive pharmacologic treatment, and coronary angiography with revascularization is used if there is evidence of spontaneous or provoked ischemia within the hospital stay.
Method: Two hundred sixty-one patients with acute coronary syndrome were enrolled in this study for early invasive strategy. Patients received aspirin, heparin, clopidogrel, and lipid-lowering therapy. The primary endpoint was a composite of death, non-fatal myocardial infarction, cerebrovascular accident, and recurrent chest pain.
Angiograms were assessed qualitatively by two expert invasive cardiologists.
Results: Sixty-seven percent of the patients underwent percutaneous (33%) or surgical (34%) revascularization. The overall death rate was 1.1%. In-hospital major adverse cardiac event (MACE) rate was 3.2% in the revascularization groups. According to the favorable in-hospital course in patients referred for PCI or CABG, it seems that accurate selection of patients who may be candidates for early invasive strategies is of paramount importance. We found that diabetes, cardiac enzyme elevations (Troponin T), ST/T changes, and the presence of two or more risk factors besides diabetes are powerful predictors of the patients who will undergo revascularization.
Conclusion: Proper selection of patients admitted with ACS for invasive strategy is warranted. Positive cardiac enzymes (Troponin T), diabetes mellitus, and presence of two or more major CAD risk factors are helpful for patient selection.