[Predictors of the use of the early invasive strategy in women with non-ST-elevation acute coronary syndrome]. / Predictores del uso de la estrategia invasiva precoz en mujeres con síndrome coronario agudo sin elevación de ST.

OBJECTIVE: To identify determinants associated to an early invasive strategy in women with acute coronary syndromes without ST elevation (NSTE-ACS). DESIGN: A retrospective cohort study was made. Crude and adjusted analysis of the performance of the early invasive strategy using logistic regression. SETTING: Coronary Units enrolled in 2010 - 2011 in the ARIAM-SEMICYUC registry. PATIENTS: A total of 440 women with NSTE-ACS were studied. Sixteen patients were excluded due to insufficient data, together with 58 patients subjected to elective coronary angiography (> 72 h). VARIABLES ANALYZED: Demographic parameters, coronary risk factors, previous medication, comorbidity. Clinical, laboratory, hemodynamic and electrocardiographic data of the episode. RESULTS: Women treated conservatively were of older age, had oral anticoagulation, diabetes, previous coronary lesions, and heart failure (p<0.005), increased baseline bleeding and ischemic risk (p=0.05) and a higher heart rate upon admission (p<0.05). After adjustment, only age > 80 years (OR 0.48, 95% CI 0.27 to 0.82, p=0.009), known coronary lesions (OR 0.47, 95% CI 0.26-0.84, p=0.011), and heart rate (OR 0.98, 95% CI 0.97-0.99, p=0.003) were independently associated to conservative treatment. Smoking (OR 2.50, 95% CI 1.20 to 5.19, p=0.013) and high-risk electrocardiogram (OR 2.96, 95% CI 1.72 to 4.97, p<0.001) were associated to the early invasive strategy. The exclusion of early deaths (<24 h) did not alter these results. CONCLUSIONS: In women with NSTE ACS, smoking and a high-risk electrocardiogram upon admission were independent factors associated to the early invasive strategy. Previous coronary lesions, age > 80 years and increased heart rate were independent factors associated to conservative treatment.

[Effectiveness and safety of triple antiaggregation in patients undergoing coronary intervention]. / Efectividad y seguridad de la "triple antiagregación" en pacientes sometidos a intervencionismo coronario.

OBJECTIVE: To evaluate glycoprotein IIb/IIIa inhibitors (GPIIb/IIIa inhibitors) effectiveness and safety in patients with non-ST segment elevation acute coronary syndrome (NSTEACS) or stable coronary disease referred for percutaneous coronary revascularization pre-treated with aspirin and thienopyridines by means of a systematic review. SOURCE OF DATA: Electronic search using Medline, Embase, Pascal, Cochrane Library and ISI Proceedings and manual review of the articles found. STUDY SELECTION: We included randomized controlled trials that assessed the clinical efficacy (risk of death or infarction) and safety (bleeding and thrombocytopenia) of GPIIb/IIIa inhibitors in patients pretreated with thienopyridines. DATA EXTRACTION: Data were obtained by duplicate. RESULTS: Nine randomized controlled trials (8,604 patients) were included. Addition of GPIIb/ IIIa inhibitors reduced the risk of death or myo-cardial infarction at 30 days in those trials that included patients with NSTEACS (RR 0.67; 95%CI 0.56-0.80) but not in studies that excluded NSTEACS patients (RR 1.07; 95%CI 0.75-1.53) (p test of interaction 0.0175), As a counterpart, GPIIb/ IIIa inhibitors increased the risk of bleeding and thrombocytopenia. CONCLUSIONS: Use of GPIIb/IIIa inhibitors reduces the risk of adverse cardiac events in NSTEACS patients pre-treated with aspirin and thienopyridines but increases the risk of severe bleeding and thrombocytopenia. Its utilization in stable coronary patients does not seem justified.