Bleeding Events Before Coronary Angiography in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome

Background The optimal timing of invasive examination and treatment of high‐risk patients with non–ST‐segment–elevation acute coronary syndrome has not been established. We investigated the efficacy of early invasive coronary angiography compared with standard‐care invasive coronary angiography on the risk of all‐cause mortality according to the GRACE (Global Registry of Acute Coronary Events) risk score in a predefined subgroup analysis of the VERDICT (Very Early Versus Deferred Invasive Evaluation Using Computerized Tomography) trial. Methods and Results Patients with clinical suspicion of non–ST‐segment–elevation acute coronary syndrome with ECG changes indicating new ischemia and/or elevated troponin, in whom invasive coronary angiography was clinically indicated and deemed logistically feasible within 12 hours, were eligible for inclusion. Patients were randomized 1:1 to an early (≤12 hours) or standard (48–72 hours) invasive strategy. The primary outcome of the present study was all‐cause mortality. Of 2147 patients randomized in the VERDICT trial, 2092 patients had an available GRACE risk score. Of these, 1021 (48.8%) patients had a GRACE score >140. During a median follow‐up of 4.1 years, 192 (18.8%) and 54 (5.0%) patients died in the high and low GRACE score groups, respectively. The risk of death with the early invasive strategy was increased in patients with a GRACE score ≤140 (hazard ratio [HR], 2.04 [95% CI, 1.16–3.59]), whereas there was a trend toward a decreased risk of death with the early invasive strategy in patients with a GRACE score >140 (HR, 0.83 [95% CI, 0.63–1.10]) ( P interaction =0.006). Conclusions In patients with non–ST‐segment–elevation acute coronary syndrome, we found a significant interaction between timing of invasive coronary angiography and GRACE score on the risk of death. Randomized clinical trials are warranted to establish the efficacy and safety among high‐risk and low‐risk patients with non–ST‐segment–elevation acute coronary syndrome. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02061891.

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Time to coronary angiography in patients with non-ST-segment elevation acute coronary syndrome: how fast should patients go to the catheterization laboratory?

Current Opinion in Cardiology ◽

10.1097/hco.0b013e328312c327 ◽

2008 ◽

Vol 23 (6) ◽

pp. 585-590 ◽

Cited By ~ 4

Author(s):

Pierluigi Tricoci

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Angiography ◽

St Segment Elevation ◽

Catheterization Laboratory ◽

Coronary Syndrome ◽

St Segment ◽

Elevation Acute Coronary Syndrome

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Sex Differences in Ischemic and Bleeding Outcomes in Patients With Non–ST-Segment–Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.120.009759 ◽

2021 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Jean-Guillaume Dillinger ◽

Gregory Ducrocq ◽

Yedid Elbez ◽

Marc Cohen ◽

Christoph Bode ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Artery Bypass ◽

Bypass Graft ◽

Coronary Intervention ◽

Bleeding Events ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

Elevation Acute Coronary Syndrome

Background: Previous studies have observed poorer outcomes in females with myocardial infarction, but older age and lower use of percutaneous coronary intervention in females are factors that potentially explain the worse outcome. This study sought to determine if female sex is an independent factor of ischemic and bleeding outcomes in non–ST-segment–elevation acute coronary syndrome treated with a systematic invasive approach. Methods: The TAO trial (Treatment of Acute Coronary Syndrome With Otamixaban) randomized patients with non–ST-segment–elevation acute coronary syndrome treated invasively to heparin plus eptifibatide versus otamixaban. In this post hoc analysis, the primary ischemic end point (all-cause death, myocardial infarction within 180 days) and the primary safety end point (Thrombolysis in Myocardial Infarction major or minor bleeding within 30 days) were analyzed according to sex. Results: Of 13 229 randomized patients, 3980 (30.1%) were females and 9249 (69.9%) were males. Females were older (64.8±11.0 versus 60.7±11.1 years), had more comorbidities, received less peri-procedural antithrombotic therapy, and underwent less frequently revascularization. Overall, females experienced a higher risk of ischemic (10.2% versus 9.1%; odds ratio [OR], 1.15 [1.01–1.30]) and bleeding events (4.2% versus 3.4%; OR, 1.23 [1.02–1.49]) than males. After multivariate analysis, the risk of ischemic outcomes (OR, 1.04 [0.90–1.19]), death (OR, 1.00 [0.75–1.23]), or bleeding (OR, 1.05 [0.85–1.28]), were similar between females and males. Only, noncoronary artery bypass graft related Thrombolysis in Myocardial Infarction major bleeding were increased in females (OR, 1.69 [1.11–2.56]). Conclusions: In patients with non–ST-segment–elevation acute coronary syndrome with systematic invasive management, ischemic outcomes, bleeding events, and mortality were higher in females. After multivariate analyses, female sex was not an independent predictor of ischemic and bleeding events although noncoronary artery bypass graft related Thrombolysis in Myocardial Infarction major bleeding was higher in females. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01076764.

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