Document Detail


Predictors of outcomes in medically treated patients with acute coronary syndromes after angiographic triage: an Acute Catheterization And Urgent Intervention Triage Strategy (ACUITY) substudy.
MedLine Citation:
PMID:  20142447     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Outcomes of patients presenting with acute coronary syndromes are improved with an early invasive approach; however, approximately one third of these patients are treated medically after angiographic screening. We sought to assess the predictors of adverse cardiac events in patients with acute coronary syndrome assigned to medical management.
METHODS AND RESULTS: This substudy of the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial included 4491 acute coronary syndrome patients treated medically after angiographic triage. Rates of bleeding and composite ischemia (death, myocardial infarction, revascularization) were compared among the 3 antithrombotic treatment arms. Composite ischemia occurred in 399 patients (9.5%) at 1 year. Treatment with bivalirudin glycoprotein IIb/IIIa inhibitors significantly reduced major bleeding at 30 days (2.5% bivalirudin monotherapy; P=0.005, 2.0% bivalirudin plus glycoprotein IIb/IIIa inhibitors; P=0.0002 versus 4.4% heparin with glycoprotein IIb/IIIa inhibitors). Composite ischemic events at 1 year were not significantly different in the 3 groups (bivalirudin monotherapy, 9.6%; bivalirudin plus glycoprotein IIb/IIIa inhibitors, 9.7%; heparin plus glycoprotein IIb/IIIa inhibitors, 9.1%). Independent predictors of composite ischemia were mostly angiographic factors at 30 days, including jeopardy score and coronary ectasia, and at 1 year, including previous percutaneous coronary intervention, jeopardy score, coronary ectasia, and increasing number of diseased vessels.
CONCLUSIONS: Among the ACUITY acute coronary syndrome patients treated medically after angiographic triage, bivalirudin therapy significantly reduced bleeding complications compared with heparin without any negative impact on ischemic outcomes at 1 year. The most powerful predictors of ischemic outcomes were angiographic rather than traditional clinical parameters, supporting the early use of angiographic screening in the moderate- and high-risk but medically treated acute coronary syndrome population. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00093158.
Authors:
Kenji Goto; Alexandra J Lansky; Martin Fahy; Ecatarina Cristea; Frederick Feit; E Magnus Ohman; Harvey D White; Karen P Alexander; Michel E Bertrand; Walter Desmet; Martial Hamon; Roxana Mehran; Gregg W Stone
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-02-08
Journal Detail:
Title:  Circulation     Volume:  121     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-23     Completed Date:  2010-03-19     Revised Date:  2011-06-06    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  853-62     Citation Subset:  AIM; IM    
Affiliation:
Cardiovascular Research Foundation, 111 E 59th St, 11th Floor, New York, NY 10022, USA.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00093158
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / complications,  drug therapy*
Aged
Anticoagulants / therapeutic use*
Coronary Angiography*
Female
Heparin / therapeutic use*
Hirudins
Humans
Male
Middle Aged
Peptide Fragments / therapeutic use*
Platelet Aggregation Inhibitors / therapeutic use*
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
Predictive Value of Tests
Recombinant Proteins / therapeutic use
Risk Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Hirudins; 0/Peptide Fragments; 0/Platelet Aggregation Inhibitors; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 0/Recombinant Proteins; 128270-60-0/bivalirudin; 9005-49-6/Heparin
Comments/Corrections
Comment In:
Med Klin (Munich). 2010 Jun;105(6):445-6   [PMID:  20593575 ]
Circulation. 2010 Nov 16;122(20):e523   [PMID:  21098465 ]
Circulation. 2010 Feb 23;121(7):843-5   [PMID:  20142452 ]
Circulation. 2011 Apr 19;123(15):e410-1
Circulation. 2010 Nov 16;122(20):e522   [PMID:  21098464 ]

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