Summary

Clinical importance of early intensive medical treatment for improving prognosis in non-ST-elevation acute coronary syndrome

Fortuny E, Núñez Gil IJ, García-Rubira JC, Ruiz Mateos B, Ibáñez B, Gonzalo N, Vivas D, Macaya C, Fernández Ortiz A

Affiliation of the authors

Unidad Coronaria. Servicio de Cardiología. Instituto Cardiovascular. Hospital Clínico San Carlos. Madrid, Spain.

DOI

Quote

Fortuny E, Núñez Gil IJ, García-Rubira JC, Ruiz Mateos B, Ibáñez B, Gonzalo N, et al. Clinical importance of early intensive medical treatment for improving prognosis in non-ST-elevation acute coronary syndrome. Emergencias. 2011;23:461-7

Summary

Background and objective: Current guidelines emphasize the importance of optimal

medical treatment for improving the prognosis of patients diagnosed with acute

coronary syndrome without persistent ST-segment elevation, although few studies have

analyzed the importance of implementing prescribing guidelines on outcomes; our aim

was to investigate this relationship.

Methods: Retrospective study of 1118 patients admitted to a coronary unit with non-STsegment

elevation acute coronary syndrome, analyzing baseline characteristics,

treatment during admission, and prognostic variables during hospitalization.

Results: In-hospital mortality was lower (P<.001) in patients who were treated with at least 5 of 7 recommended drugs (acetylsalicylic acid, anticoagulants, glycoprotein IIb/IIIa inhibitors, clopidogrel, â-blockers, angiotensin-converting enzyme inhibitors, and statins) during emergency admission. Maximum in-hospital Killip score (P<.001) and the prevalence of a composite outcome (death, repeat myocardial infarct, Killip class 3 or 4) (P<.001) were also related to the number of drugs prescribed. In addition, our analysis revealed the prognostic relevance of degree of heart failure at admission and the severity of coronary disease. Conclusions: These findings suggest that benefit derives from prescribing the largest possible number of currently recommended drugs when managing high-risk acute coronary syndrome without persistent ST-segment elevation. In this patient series, failing to administer more than 2 of the recommended drugs had a significant effect on outcome. Recommended drugs should be excluded only if strongly contraindicated.

 

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