TY - JOUR
T1 - Early versus delayed invasive strategy in patients with non-ST-elevation acute coronary syndrome and concomitant congestive heart failure
AU - Yoshida, Ruka
AU - Ishii, Hideki
AU - Morishima, Itsuro
AU - Tanaka, Akihito
AU - Morita, Yasuhiro
AU - Takagi, Kensuke
AU - Yoshioka, N.
AU - Hirayama, Kenshi
AU - Iwakawa, N.
AU - Tashiro, Hiroshi
AU - Kojima, Hiroki
AU - Mitsuda, Takayuki
AU - Hitora, Yusuke
AU - Furusawa, K.
AU - Tsuboi, Hideyuki
AU - Murohara, Toyoaki
N1 - Funding Information:
H.I. received lecture fees from Astellas Pharma Inc., Bayer Pharmaceutical Co., Ltd., Daiichi-Sankyo Pharma Inc., and MSD K. K. T.M. received lecture fees from Bayer Pharmaceutical Co., Ltd., Daiichi-Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Kowa Co., Ltd., MSD K. K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K. K., Pfizer Japan Inc., Sanofi-Aventis K. K., and Takeda Pharmaceutical Co., Ltd. T.M. received unrestricted research grant for Department of Cardiology, Nagoya University Graduate School of Medicine from Astellas Pharma Inc., Daiichi-Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Kowa Co., Ltd., MSD K. K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K. K., Otsuka Pharma Ltd., Pfizer Japan Inc., Sanofi-Aventis K. K., Takeda Pharmaceutical Co., Ltd., and Teijin Pharma Ltd. For the remaining authors none were declared.
Publisher Copyright:
© 2019 Japanese College of Cardiology
PY - 2019/10
Y1 - 2019/10
N2 - Background: Although there are guidelines that recommend an early invasive strategy in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) and concomitant congestive heart failure (CHF), optimal timing of the invasive strategy remains controversial. Methods: Among 2045 patients who were admitted owing to NSTE-ACS or CHF, 300 presented with NSTE-ACS and concomitant CHF. Of the 300 patients, we enrolled 160 patients for whom coronary angiography (CAG) during their hospital stay was planned at the time of admission; 64 of these patients were classified into the early invasive group (<24 h) and 96 were classified to the delayed invasive group (≥24 h). We evaluated the primary outcome which was defined as a composite of cardiac mortality, life-threatening arrhythmia, and non-fatal myocardial infarction (MI). Results: The median time between presentation and CAG was 2 h in the early invasive group and 240 h in the delayed group. During follow-up, the primary outcome was significantly lower in the early invasive group [hazard ratio (HR), 0.52; 95% confidence interval (CI), 0.30–0.87; p = 0.01]. After the adjustment of confounding factors, the primary outcome was significantly less frequent (HR, 0.44; 95% CI, 0.23–0.78; p = 0.004) in the early invasive group compared to the delayed invasive group. Conclusions: The early invasive strategy was associated with a lower risk of the composite primary outcome in the long-term follow-up of patients with NSTE-ACS and concomitant CHF.
AB - Background: Although there are guidelines that recommend an early invasive strategy in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) and concomitant congestive heart failure (CHF), optimal timing of the invasive strategy remains controversial. Methods: Among 2045 patients who were admitted owing to NSTE-ACS or CHF, 300 presented with NSTE-ACS and concomitant CHF. Of the 300 patients, we enrolled 160 patients for whom coronary angiography (CAG) during their hospital stay was planned at the time of admission; 64 of these patients were classified into the early invasive group (<24 h) and 96 were classified to the delayed invasive group (≥24 h). We evaluated the primary outcome which was defined as a composite of cardiac mortality, life-threatening arrhythmia, and non-fatal myocardial infarction (MI). Results: The median time between presentation and CAG was 2 h in the early invasive group and 240 h in the delayed group. During follow-up, the primary outcome was significantly lower in the early invasive group [hazard ratio (HR), 0.52; 95% confidence interval (CI), 0.30–0.87; p = 0.01]. After the adjustment of confounding factors, the primary outcome was significantly less frequent (HR, 0.44; 95% CI, 0.23–0.78; p = 0.004) in the early invasive group compared to the delayed invasive group. Conclusions: The early invasive strategy was associated with a lower risk of the composite primary outcome in the long-term follow-up of patients with NSTE-ACS and concomitant CHF.
UR - http://www.scopus.com/inward/record.url?scp=85070185621&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85070185621&partnerID=8YFLogxK
U2 - 10.1016/j.jjcc.2019.03.006
DO - 10.1016/j.jjcc.2019.03.006
M3 - Article
C2 - 31401985
AN - SCOPUS:85070185621
VL - 74
SP - 320
EP - 327
JO - Journal of Cardiology
JF - Journal of Cardiology
SN - 0914-5087
IS - 4
ER -