What is the optimal length of stay in hospital for ST elevation myocardial infarction tre…

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The diagnostic and prognostic value of first hour glycogen phosphorylase isoenzyme BB lev…

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In-hospital management and mortality in elderly patients with non-ST-segment elevation acute coronary syndromes treated in centers without on-site invasive facilities.

Cardiol J. 2008;15(5):451-7

Authors: Dziewierz A, Siudak Z, Rakowski T, Zdzienicka J, Dykla D, Mielecki W, Dubiel JS, Dudek D

BACKGROUND: The purpose was to assess age-related differences in hospital management and mortality in non-ST-elevation acute coronary syndrome (NSTE ACS) patients treated conservatively, with a focus on the influence of aggressive pharmacological treatment on in-hospital clinical outcome. METHODS: We identified 807 NSTE ACS patients treated conservatively in the 29 hospitals participating in the Krakow Registry of Acute Coronary Syndromes from February to March 2005 and from December 2005 to January 2006. Out of 807 patients' 32.1% were less than 65 years of age, 33% from 65 to 74, 30.5% from 75 to 84, and 5.3% >or= 85. For all patients, pharmacotherapy index based on the use of pharmacological treatment regimen during hospital stay was assessed. Each patient received 1 point for each of the following guideline-recommended drugs used: aspirin, clopidogrel, glycoprotein IIb/IIIa inhibitor, LMWH, beta-blocker, ACE inhibitor/angiotensin II receptor blocker and statin – the range of points being from 0 to 7. RESULTS: Significant age-related differences in baseline characteristics and pharmacotherapy index values were found. In-hospital mortality was higher in elderly patients (2.4% vs. 3.4% vs. 8.9% vs. 14.0%, respectively for age groups, p < 0.0001). Similarly, in non-shock patients and in patients with elevated cardiac markers, age-dependent differences in mortality were observed. Independent predictors of in-hospital death were: age, cardiogenic shock, elevated cardiac markers and pharmacotherapy index. CONCLUSIONS: Advanced age is associated with less aggressive pharmacological treatment and higher in-hospital mortality in NSTE ACS patients remaining in community hospitals for conservative treatment. Broader implementation of current guidelines and more frequent invasive treatment might improve the outcomes of NSTE ACS patients regardless of age.

PMID: 18810721 [PubMed - indexed for MEDLINE]

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Outcome of patients with stable angina pectoris treated with or without percutaneous coronary intervention.

Cardiol J. 2008;15(3):226-9

Authors: Gu Y, Hu Y, Hu L, Cheng Z, Li L

BACKGROUND: To assess the outcome of patients with stable angina pectoris treated with percutaneous coronary intervention versus medically treated patients. METHODS: Eighty patients with stable angina pectoris and coronary stenosis as confirmed in coronary angiography were treated with (n = 31) or without (n = 49) percutaneous coronary intervention in our department. All patients received optimal medical therapy and were followed up for a period of 24 months. RESULTS: Baseline clinical characteristics, including risk factors of coronary heart disease and coronary lesion type did not differ between the two groups (all p > 0.05). There was no significant difference in major adverse cardiac events (22.4% vs. 22.6%) during the 24 month follow-up between the two groups (p > 0.05). CONCLUSIONS: Percutaneous coronary intervention did not provide extra benefit in this group of patients with stable angina pectoris receiving standard medical treatment in terms of 24 months major adverse outcomes.

PMID: 18651414 [PubMed - indexed for MEDLINE]

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