|The Organization to Assess Strategies for Ischemic Syndromes (OASIS) registry in patients with unstable angina.|
|PMID: 10505537 Owner: NLM Status: MEDLINE|
|Clinical approaches to the prevention of the potentially catastrophic consequences of coronary ischemic phenomena such as unstable angina and suspected non-Q-wave myocardial infarction (MI) differ across the world. In addition to prevailing physician beliefs in different societies, the level of access to catheterization laboratories largely determines whether an interventionist or conservative strategy is adopted. The Organization to Assess Strategies for Ischemic Syndromes (OASIS)--a prospective registry of approximately 8,000 patients with acute myocardial ischemia with no ST elevation, treated in 95 hospitals across 6 countries--furnished a unique window into regional differences in clinical management and the frequency and timing of invasive procedures (i.e., angiography, percutaneous transluminal coronary angioplasty [PTCA], and coronary artery bypass graft [CABG] surgery), as well as the outcomes of these trends. At 6 months after symptom onset, patients in the United States and Brazil, where the catheterization laboratory facilities are more accessible, underwent significantly (p <0.001) more angiography (69.4%), PTCA (23.6%), and CABG (25.2%) than in Canada and Australia, where the corresponding rates were 48.4%, 17.0%, and 16.8% (p <0.001), respectively; and in Hungary and Poland, where the respective rates were 23.5%, 5.8%, and 10.9% (p <0.001). This relatively aggressive approach led at 6 months to a more substantial decrease in refractory angina in the United States and Brazil than in Canada and Australia (20.4% vs 13.9%; p <0.001), but no improvement in rates of cardiovascular mortality and MI (10.5% versus 10.5%; p = 0.36). There was a significant (p < or = 0.012) increase in stroke, (1.9% vs 1.3%; p = 0.010) and major bleeding (1.9% vs 1.1%; p = 0.009) events. Furthermore, an inverse correlation emerged between baseline cardiovascular risk status and frequency of angiography and PTCA interventions preferentially for low-risk compared with high-risk patients. In concert with findings from other recent randomized trials, the OASIS Registry data suggest that although there are fewer hospital readmissions for unstable angina, there is a trend toward increased rates of death, MI, and stroke. These data urge a cautious approach to the use of invasive procedures in patients with unstable angina unless future trials demonstrate a clear benefit with an aggressive approach.|
|L S Piegas; M Flather; J Pogue; D Hunt; J Varigos; A Avezum; J Anderson; M Keltai; A Budaj; K Fox; L Ceremuzynski; S Yusuf|
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|Type: Journal Article|
|Title: The American journal of cardiology Volume: 84 ISSN: 0002-9149 ISO Abbreviation: Am. J. Cardiol. Publication Date: 1999 Sep|
|Created Date: 1999-10-07 Completed Date: 1999-10-07 Revised Date: 2004-11-17|
Medline Journal Info:
|Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: UNITED STATES|
|Languages: eng Pagination: 7M-12M Citation Subset: AIM; IM|
|Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.|
|APA/MLA Format Download EndNote Download BibTex|
Angina, Unstable / diagnosis*, drug therapy, radiography, surgery, therapy*
Angioplasty, Transluminal, Percutaneous Coronary / adverse effects
Anticoagulants / therapeutic use
Calcium Channel Blockers / therapeutic use
Cerebrovascular Disorders / etiology
Coronary Artery Bypass / adverse effects
Death, Sudden, Cardiac / etiology
Length of Stay
Myocardial Infarction / etiology
Vasodilator Agents / therapeutic use
|0/Adrenergic beta-Antagonists; 0/Anticoagulants; 0/Calcium Channel Blockers; 0/Vasodilator Agents|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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