Key result
Increased implementation of a routine invasive strategy for NSTE-ACS over 12 years (from 3.8% to 37.4%) was associated with a decrease in three-year all-cause mortality from 29.1% to 23.9%.
Why the study?
Does a routine invasive strategy reduce three-year all-cause mortality in patients with NSTE-ACS?
Cohort (n=204,092)
Yes
Does a routine invasive strategy reduce three-year all-cause mortality in patients with NSTE-ACS?
The implementation of a routine invasive strategy for NSTE-ACS increased significantly over 12 years in Sweden, which was associated with a gradual decrease in three-year all-cause mortality.
Answers are grounded in this paper and cite their sources.
Supports wider invasive strategy use in NSTE-ACS; extends observational trends but leaves causality open for RCTs.
AIMS: Despite recommendations in recent guidelines for a routine invasive strategy for non-ST-segment elevation acute coronary syndrome (NSTE-ACS), long-term data on the implementation of treatment strategies in clinical practice are not available. Our aim was to provide long-term data on the implementation of a routine invasive strategy in NSTE-ACS in clinical practice. METHODS AND RESULTS: In the SWEDEHEART registry, data from 204,092 consecutive NSTE-ACS patients admitted between 1996 and 2007 were recorded. The use of the routine invasive strategy, retrospectively defined as coronary angiography (and subsequent revascularisation) within three days after admission, increased from 3.8% in the period 1996-1998 to 37.4% in the period 2005-2007. The largest absolute increase in the use of this strategy was observed in low-risk patients, while a similar relative increase was observed in all risk categories. The use of the selective invasive strategy, defined as coronary angiography later than three days after admission or none at all, decreased from 96.2% in the period 1996-1998 to 62.5% in the period 2005-2007. In the total population, there was a gradual decrease in three-year all-cause mortality, from 29.1% in the period 1996-1998 to 23.9% in the period 2005-2007. CONCLUSIONS: There has been an increase in the use of a routine invasive strategy in NSTE-ACS patients over the course of 12 years in Sweden. There was a decrease in three-year mortality over the same time course.
No takes yet. Share an insight, caveat, or question.
Damman et al. (2016) conducted a cohort in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) (n=204,092). Routine invasive strategy implementation (2005-2007 period) vs. 1996-1998 period was evaluated on Three-year all-cause mortality. Increased implementation of a routine invasive strategy for NSTE-ACS over 12 years (from 3.8% to 37.4%) was associated with a decrease in three-year all-cause mortality from 29.1% to 23.9%.
Synapse has enriched 10 related papers. Consider them for comparative context: