Key result
An early invasive strategy was associated with a lower risk for cardiac death compared with a conservative approach (5.9% vs. 7.6%; HR 0.75; 95% CI 0.66-0.84; P<0.001) in patients with a first ACS.
Why the study?
Does an early invasive treatment strategy reduce cardiac death or rehospitalization for MI in patients with a first acute coronary syndrome compared to a conservative invasive approach?
Cohort (n=19,704)
Yes
Does an early invasive treatment strategy reduce cardiac death or rehospitalization for MI in patients with a first acute coronary syndrome compared to a conservative invasive approach?
Hazard Ratio: 0.75 (95% CI 0.66–0.84)
Absolute Event Rate: 5.9% vs 7.6%
p-value: p=< 0.001
In a real-world national cohort, an early invasive strategy for first acute coronary syndrome was associated with significantly lower risks of short-term cardiac death and MI rehospitalization compared to a conservative approach, extending findings from randomized trials.
Supports early invasive consideration in first ACS; extends randomized evidence to real-world cohorts but remains hypothesis-generating.
BACKGROUND: Randomized clinical trials have found that early invasive strategies reduce mortality, myocardial infarction (MI), and rehospitalization compared with a conservative invasive approach in acute coronary syndromes (ACSs), but the effectiveness of such strategies in real-world settings is unknown. OBJECTIVE: To investigate adverse cardiovascular outcomes of an early versus a conservative invasive strategy in a national cohort of patients with ACSs. DESIGN: Retrospective cohort study. SETTING: Administrative health care data on hospitalizations, procedures, and outcomes abstracted from the Danish national registries and covering all acute invasive procedures in patients presenting with an ACS. PATIENTS: 19 704 propensity score-matched patients hospitalized with a first ACS between 1 January 2005 and 31 December 2011. MEASUREMENTS: Risk for cardiac death or rehospitalization for MI within 60 days of hospitalization. RESULTS: Compared with a conservative approach, early invasive strategies were associated with a lower risk for cardiac death (cumulative incidence, 5.9% vs. 7.6%; adjusted hazard ratio [HR], 0.75 [95% CI, 0.66 to 0.84]; P < 0.001). Similar results were found for rehospitalization for MI (cumulative incidence, 3.4% vs. 5.0%; adjusted odds ratio, 0.67 [CI, 0.58 to 0.77]; P < 0.001) and all-cause death (cumulative incidence, 7.3% vs. 10.6%; adjusted HR, 0.65 [CI, 0.59 to 0.72]; P < 0.001). LIMITATION: Potential residual confounding due to lack of core clinical variables. CONCLUSION: In this real-world cohort of patients with a first hospitalization for an ACS, the use of an early invasive treatment strategy was associated with a lower risk for cardiac death and rehospitalization for MI compared with a conservative invasive approach. PRIMARY FUNDING SOURCE: Department of Cardiology, University Hospital Gentofte.
No takes yet. Share an insight, caveat, or question.
Hansen et al. (2015) conducted a cohort in Acute coronary syndromes (n=19,704). Early invasive strategy vs. Conservative invasive approach was evaluated on Cardiac death within 60 days of hospitalization (HR 0.75, 95% CI 0.66 to 0.84, p=< 0.001). An early invasive strategy was associated with a lower risk for cardiac death compared with a conservative approach (5.9% vs. 7.6%; HR 0.75; 95% CI 0.66-0.84; P<0.001) in patients with a first ACS.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: