All participants provided written informed consent and the study protocols were approved by the institutional review board at each enrolling center.įlowchart of Study Population Consisting of NSTEMIs Enrolled From the Observational, Multi-Center, Prospective PREMIER and TRIUMPH RegistriesĪbbreviations: NSTEMI, non-ST-elevation myocardial infarction PREMIER, Prospective Registry Evaluating outcomes after Myocardial Infarctions: Events and Recovery STEMI, ST-elevation myocardial infarction TRIUMPH, Translational Research Investigating Underlying disparities in acute Myocardial infarction Patients’ Health status.Ī total of 3853 NSTEMI patients (1409 from PREMIER, 2444 from TRIUMPH) were identified patients who died in hospital were excluded ( Figure 1), leaving a final study cohort of 3819 patients. Patients that were incarcerated, who refused participation, were unable to provide informed consent, did not speak English or Spanish, and those that expired during hospitalization before they could consent to participate in the study were excluded. 10, 11 In both registries, patients were enrolled if they were aged 18 years or older, had biomarker evidence of myocardial injury, and presented with supporting evidence of an AMI, including prolonged ischemic symptoms or electrocardiographic ST changes. The design of both studies has been previously described. – PREMIER and TRIUMPH – that consecutively enrolled patients between 20 from 32 academic and non-academic centers ( Figure 1 and Appendix I for List of Sites). We leveraged 2 consecutive, multi-center, prospective acute myocardial infarction (AMI) registries in the U.S. to examine the association of pre-infarct angina, quality of life and mortality risk with treatment strategy for patient presenting with NSTEMI. To address this gap in knowledge, we leveraged 2 sequential, prospective, multi-center, post-acute myocardial infarction registries in the U.S. 9 However, no data currently exist to describe the patterns of selecting patients for an invasive treatment strategy in the setting of NSTEMI as a function of their pre-infarct health status. 8 Moreover, recent data suggest that an invasive strategy for NSTEMI was associated with significantly better 30-day health status among patients with pre-infarct angina (PIA). angina episodes preceding the onset of acute myocardial infarction (AMI), occurs in almost half of patients presenting with NSTEMI 7, 8 and a prior study have suggested that it is associated with higher rates of significant coronary artery disease (CAD). 2– 5 Given that patients’ with significant angina prior to a NSTEMI also have more angina afterwards, 6 it would be clinically logical to pursue a more aggressive treatment strategy in those with worse pre-infarct angina and angina-related quality of life. Further work is needed to understand the role of pre-infarct health status and in-hospital treatment strategy.ĭespite evidence that patients with non-ST elevation myocardial infarction (NSTEMI)with the greatest mortality risk benefit most from an invasive strategy, 1 many studies have documented that higher-risk patients are less often managed invasively. In conclusion, this real-world NSTEMI cohort, patients with the highest mortality risk and worst health status were less likely to be referred for early invasive management. Finally, patients with a GRACE score in the highest risk decile (199.5–<321.4) had significantly lower rates of early invasive treatment (42.7%) as compared with patients with patients in the lowest decile of risk (67.6% adjusted RR for continuous GRACE score per SD, 0.96, 95% CI: 0.92–0.99, P.019). Patients with excellent, good, or very good baseline angina-specific quality of life, respectively, were more likely to receive early angiography, even after adjustment, as compared with patients reporting poor baseline quality of life due to angina (62.1.0%, 60.9%, 59.6%, vs. Of 3,768 NSTEMI patients, 2182 (57.9%) patients were referred for early invasive treatment. multi-center registries, in which the associations between pre-infarct angina frequency and quality of life (both assessed by the Seattle Angina Questionnaire on admission) and the GRACE risk score and referral to early invasive management (coronary angiography within 48 hours) were evaluated using Poisson regression, after adjusting for site, demographics, and clinical and psychosocial variables. ![]() The association between pre-infarct health status and the selecting patients for early invasive management is unknown. Early invasive management improves outcomes in non-ST-elevation myocardial infarction (NSTEMI).
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