Invasive management of acute coronary syndrome: Interaction with competing risks.
Int J Cardiol
; 269: 13-18, 2018 Oct 15.
Article
en En
| MEDLINE
| ID: mdl-30037631
ABSTRACT
BACKGROUND:
The aim of this study was to characterise the interaction between ACS- and non-ACS-risk on the benefits of invasive management in patients presenting with acute coronary syndrome (ACS).METHODS:
Consecutive patients admitted to a tertiary hospital's Cardiac Care Unit in the months of July-December, 2003-2011 with troponin elevation (>30â¯ng/L) were included. "ACS-specific-risk" was estimated using the GRACE score and "non-ACS-risk" was estimated using the Charlson-Comorbidity-Index (CCI). Inverse-probability-of-treatment weighting was used to adjust for baseline differences between patients who did or did not receive invasive management. A multivariable flexible parametric model was used to characterise the time-varying hazard.RESULTS:
In total, 3057 patients were included with a median follow-up of 9.0â¯years. Based on CCI, 1783 patients were classified as 'low-non-ACS risk' (CCIâ¯≤â¯1; invasive management 81%; 12-month mortality 5%), 820 as 'medium-non-ACS risk' (CCI 2-3; invasive management 68%; 12-month mortality 13%), and 468 as 'high-non-ACS risk' (CCIâ¯≥â¯4; invasive management 47%; 12-month mortality 29%). After adjustment, invasive management was associated with a significant reduction in one-year overall-mortality in the 'low-risk' and 'medium-risk' groups (HRâ¯=â¯0.38, 95%CI0.26-0.56; HRâ¯=â¯0.46, 95%CI0.32-0.67); but not in the 'high-risk' group (HRâ¯=â¯1.02, 95%CI0.67-1.56). The absolute benefit of invasive management was greatest with higher baseline ACS-risk, with a non-linear interaction between ACS- and non-ACS-risk.CONCLUSIONS:
There is a complex interaction between ACS- and non-ACS-risk on the benefit of invasive management. These results highlight the need to develop robust methods to objectively quantify risk attributable to non-ACS comorbidities in order to make informed decisions regarding the use of invasive management in individuals with numerous comorbidities.Palabras clave
Texto completo:
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Bases de datos:
MEDLINE
Asunto principal:
Manejo de la Enfermedad
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Síndrome Coronario Agudo
Tipo de estudio:
Diagnostic_studies
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Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Int J Cardiol
Año:
2018
Tipo del documento:
Article