Key result
Invasive management for ACS linked to ~26% lower one-year mortality versus previous management.
Why the study?
The study was conducted to analyze whether changing management tactics in patients with ACS in clinical practice from 2004 through 2018 improved prognosis.
Does introducing invasive management tactics reduce mortality and recurrent coronary complications in patients with acute coronary syndrome?
Observational (n=2,845)
Yes
Does introducing invasive management tactics reduce mortality and recurrent coronary complications in patients with acute coronary syndrome?
Absolute Event Rate: 6.1% vs 8.2%
The transition to invasive management strategies for acute coronary syndrome over a decade was associated with significant reductions in one-year all-cause mortality and recurrent coronary complications.
May support invasive ACS management; leaves open causal confirmation in randomized trials.
Aim To analyze results of changing the management tactics in patients with acute coronary syndrome (ACS) in clinical practice from 2004 through 2018 expressed as improvement in prognosis.Material and methods Results of two observational studies were analyzed: ORACLE I (2004-2007), which included 1193 patients with ACS (mean age, 61.1±11.69 years; men, 63.3 %) and ORACLE II (2014-2017), which included 1652 patients from 4 vascular centers (mean age, 64.61±12.67 years; men, 62.3 %).Results Patients included into the ORACLE II study in 2014 were significantly older and the proportion of patients with diabetes mellitus was greater than in the ORACLE I study (14.7 and 22.6 %, respectively). After matching the groups by major clinical characteristics, it was found that introducing the invasive management tactics for ACS patients was associated with a reduced rate of all-cause death (from 8.2 to 6.1 % for one year), a tendency towards decreased number of coronary death cases (from 5.6 to 4.0 %), and a decrease in risk of recurrent coronary complications (from 17.4 to 7.7 %).Conclusion Implementing the vascular program statistically significantly decreased the total death rate for at least one-year observation in comparable patient groups.
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Zateyshchikov et al. (2020) conducted an observational in acute coronary syndrome (n=2,845). Invasive management tactics vs. Previous management tactics (2004-2007 cohort) was evaluated on all-cause death. Introducing invasive management tactics for acute coronary syndrome was associated with a reduced one-year rate of all-cause death (6.1% vs 8.2%) compared to previous management.
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