Document Detail

Myocardial revascularization reverses adverse outcome in non-ST-elevation acute coronary syndromes complicated by heart failure.
MedLine Citation:
PMID:  21066967     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Congestive heart failure (CHF) has a strong negative prognostic impact in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). The purpose of this study was to establish the effect of myocardial revascularization on prognosis in this setting.
METHODS: We retrospectively studied 648 patients admitted with NSTE-ACS and not presenting cardiogenic shock. The effect of coronary revascularization on the outcome of patients with and without CHF was assessed using a propensity score-adjusted regression model.
RESULTS: Congestive heart failure was present in 89 patients (14.5%) on hospital admission. During the index hospitalization, 426 patients received myocardial revascularization, through percutaneous coronary intervention (PCI) in 321 cases, and coronary artery bypass grafting (CABG) in 105. In a 6-month follow-up, 38 patients (6.2%) died and 42 (6.8%) experienced non-fatal myocardial infarction (MI). CHF was an independent predictor of both 6-month mortality (adjusted HR 3.6; 95% CI 1.86-6.95; p < 0.001) and 6-month death/(re-)MI (adjusted HR 2.1; 95% CI 1.3-3.5; p = 0.003). Revascularization significantly influenced the prognosis of patients presenting CHF (adjusted HR 0.31; 95% CI 0.13-0.73; p = 0.008), but not of those without CHF (adjusted HR 1.37; 95% CI 0.65-2.89; p = 0.4). A significant interaction was found between revascularization and the prognostic impact of CHF at admission (p = 0.021 for the interaction).
CONCLUSIONS: In patients with NSTE-ACS, clinical manifestations of CHF constitute a strong predictor of adverse medium-term outcome that may be significantly modified by myocardial revascularization.
Luís Raposo; Carlos Aguiar; Jorge Ferreira; Pedro Araújo de Gonçalves; António Ferreira; José Aniceto da Silva
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology     Volume:  29     ISSN:  0870-2551     ISO Abbreviation:  Rev Port Cardiol     Publication Date:    2010 Jul-Aug
Date Detail:
Created Date:  2010-11-11     Completed Date:  2011-01-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8710716     Medline TA:  Rev Port Cardiol     Country:  Portugal    
Other Details:
Languages:  eng     Pagination:  1131-42     Citation Subset:  IM    
Servçgo de Cardiologia, Hospital de Santa Cruz, Carnaxide, Portugal.
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MeSH Terms
Acute Coronary Syndrome / complications*,  physiopathology,  surgery*
Heart Failure / complications*
Myocardial Revascularization*
Retrospective Studies
Treatment Outcome

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