Effectiveness of an Early Versus Conservative Invasive Treatment Strategy in Acute Coronary Syndromes: A Nationwide Cohort Study

Kim Wadt Hansen; Rikke Sorensen; Mette Madsen; Jan Kyst Madsen; Jan Skov Jensen; Lene Mia von Kappelgaard; Poul Erik Mortensen; Theis Lange; Søren Galatius

doi:10.7326/M15-0303

Effectiveness of an Early Versus Conservative Invasive Treatment Strategy in Acute Coronary Syndromes: A Nationwide Cohort Study

Kim Wadt Hansen, Rikke Sorensen, Mette Madsen, Jan Kyst Madsen, Jan Skov Jensen, Lene Mia von Kappelgaard, Poul Erik Mortensen, Theis Lange, Søren Galatius

5 Citations (Scopus)

Abstract

Background: Randomized clinical trials have found that early invasive strategies reduce mortality, myocardial infarction (MI), and rehospitalization compared with a conservative invasive approach in acute coronary syndromes (ACSs), but the effectiveness of such strategies in real-world settings is unknown. Objective: To investigate adverse cardiovascular outcomes of an early versus a conservative invasive strategy in a national cohort of patients with ACSs. Design: Retrospective cohort study. Setting: Administrative health care data on hospitalizations, procedures, and outcomes abstracted from the Danish national registries and covering all acute invasive procedures in patients presenting with an ACS. Patients: 19 704 propensity score-matched patients hospitalized with a first ACS between 1 January 2005 and 31 December 2011. Measurements: Risk for cardiac death or rehospitalization for MI within 60 days of hospitalization. Results: Compared with a conservative approach, early invasive strategies were associated with a lower risk for cardiac death (cumulative incidence, 5.9% vs. 7.6%; adjusted hazard ratio [HR], 0.75 [95% CI, 0.66 to 0.84]; P < 0.001). Similar results were found for rehospitalization for MI (cumulative incidence, 3.4% vs. 5.0%; adjusted odds ratio, 0.67 [CI, 0.58 to 0.77]; P < 0.001) and all-cause death (cumulative incidence, 7.3% vs. 10.6%; adjusted HR, 0.65 [CI, 0.59 to 0.72]; P < 0.001). Limitation: Potential residual confounding due to lack of core clinical variables. Conclusion: In this real-world cohort of patients with a first hospitalization for an ACS, the use of an early invasive treatment strategy was associated with a lower risk for cardiac death and rehospitalization for MI compared with a conservative invasive approach. Primary Funding Source: Department of Cardiology, University Hospital Gentofte.

Original language	English
Journal	Annals of Internal Medicine
Volume	163
Issue number	10
Pages (from-to)	737-746
Number of pages	10
ISSN	0003-4819
DOIs	https://doi.org/10.7326/M15-0303
Publication status	Published - 17 Nov 2015

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@article{ae618235f5db4727a7580c1f3b468197,

title = "Effectiveness of an Early Versus Conservative Invasive Treatment Strategy in Acute Coronary Syndromes: A Nationwide Cohort Study",

abstract = "Background: Randomized clinical trials have found that early invasive strategies reduce mortality, myocardial infarction (MI), and rehospitalization compared with a conservative invasive approach in acute coronary syndromes (ACSs), but the effectiveness of such strategies in real-world settings is unknown. Objective: To investigate adverse cardiovascular outcomes of an early versus a conservative invasive strategy in a national cohort of patients with ACSs. Design: Retrospective cohort study. Setting: Administrative health care data on hospitalizations, procedures, and outcomes abstracted from the Danish national registries and covering all acute invasive procedures in patients presenting with an ACS. Patients: 19 704 propensity score-matched patients hospitalized with a first ACS between 1 January 2005 and 31 December 2011. Measurements: Risk for cardiac death or rehospitalization for MI within 60 days of hospitalization. Results: Compared with a conservative approach, early invasive strategies were associated with a lower risk for cardiac death (cumulative incidence, 5.9% vs. 7.6%; adjusted hazard ratio [HR], 0.75 [95% CI, 0.66 to 0.84]; P < 0.001). Similar results were found for rehospitalization for MI (cumulative incidence, 3.4% vs. 5.0%; adjusted odds ratio, 0.67 [CI, 0.58 to 0.77]; P < 0.001) and all-cause death (cumulative incidence, 7.3% vs. 10.6%; adjusted HR, 0.65 [CI, 0.59 to 0.72]; P < 0.001). Limitation: Potential residual confounding due to lack of core clinical variables. Conclusion: In this real-world cohort of patients with a first hospitalization for an ACS, the use of an early invasive treatment strategy was associated with a lower risk for cardiac death and rehospitalization for MI compared with a conservative invasive approach. Primary Funding Source: Department of Cardiology, University Hospital Gentofte.",

author = "Hansen, {Kim Wadt} and Rikke Sorensen and Mette Madsen and Madsen, {Jan Kyst} and Jensen, {Jan Skov} and {von Kappelgaard}, {Lene Mia} and Mortensen, {Poul Erik} and Theis Lange and S{\o}ren Galatius",

year = "2015",

month = nov,

day = "17",

doi = "10.7326/M15-0303",

language = "English",

volume = "163",

pages = "737--746",

journal = "Annals of Internal Medicine",

issn = "0003-4819",

publisher = "American College of Physicians",

number = "10",

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TY - JOUR

T1 - Effectiveness of an Early Versus Conservative Invasive Treatment Strategy in Acute Coronary Syndromes

T2 - A Nationwide Cohort Study

AU - Hansen, Kim Wadt

AU - Sorensen, Rikke

AU - Madsen, Mette

AU - Madsen, Jan Kyst

AU - Jensen, Jan Skov

AU - von Kappelgaard, Lene Mia

AU - Mortensen, Poul Erik

AU - Lange, Theis

AU - Galatius, Søren

PY - 2015/11/17

Y1 - 2015/11/17

N2 - Background: Randomized clinical trials have found that early invasive strategies reduce mortality, myocardial infarction (MI), and rehospitalization compared with a conservative invasive approach in acute coronary syndromes (ACSs), but the effectiveness of such strategies in real-world settings is unknown. Objective: To investigate adverse cardiovascular outcomes of an early versus a conservative invasive strategy in a national cohort of patients with ACSs. Design: Retrospective cohort study. Setting: Administrative health care data on hospitalizations, procedures, and outcomes abstracted from the Danish national registries and covering all acute invasive procedures in patients presenting with an ACS. Patients: 19 704 propensity score-matched patients hospitalized with a first ACS between 1 January 2005 and 31 December 2011. Measurements: Risk for cardiac death or rehospitalization for MI within 60 days of hospitalization. Results: Compared with a conservative approach, early invasive strategies were associated with a lower risk for cardiac death (cumulative incidence, 5.9% vs. 7.6%; adjusted hazard ratio [HR], 0.75 [95% CI, 0.66 to 0.84]; P < 0.001). Similar results were found for rehospitalization for MI (cumulative incidence, 3.4% vs. 5.0%; adjusted odds ratio, 0.67 [CI, 0.58 to 0.77]; P < 0.001) and all-cause death (cumulative incidence, 7.3% vs. 10.6%; adjusted HR, 0.65 [CI, 0.59 to 0.72]; P < 0.001). Limitation: Potential residual confounding due to lack of core clinical variables. Conclusion: In this real-world cohort of patients with a first hospitalization for an ACS, the use of an early invasive treatment strategy was associated with a lower risk for cardiac death and rehospitalization for MI compared with a conservative invasive approach. Primary Funding Source: Department of Cardiology, University Hospital Gentofte.

AB - Background: Randomized clinical trials have found that early invasive strategies reduce mortality, myocardial infarction (MI), and rehospitalization compared with a conservative invasive approach in acute coronary syndromes (ACSs), but the effectiveness of such strategies in real-world settings is unknown. Objective: To investigate adverse cardiovascular outcomes of an early versus a conservative invasive strategy in a national cohort of patients with ACSs. Design: Retrospective cohort study. Setting: Administrative health care data on hospitalizations, procedures, and outcomes abstracted from the Danish national registries and covering all acute invasive procedures in patients presenting with an ACS. Patients: 19 704 propensity score-matched patients hospitalized with a first ACS between 1 January 2005 and 31 December 2011. Measurements: Risk for cardiac death or rehospitalization for MI within 60 days of hospitalization. Results: Compared with a conservative approach, early invasive strategies were associated with a lower risk for cardiac death (cumulative incidence, 5.9% vs. 7.6%; adjusted hazard ratio [HR], 0.75 [95% CI, 0.66 to 0.84]; P < 0.001). Similar results were found for rehospitalization for MI (cumulative incidence, 3.4% vs. 5.0%; adjusted odds ratio, 0.67 [CI, 0.58 to 0.77]; P < 0.001) and all-cause death (cumulative incidence, 7.3% vs. 10.6%; adjusted HR, 0.65 [CI, 0.59 to 0.72]; P < 0.001). Limitation: Potential residual confounding due to lack of core clinical variables. Conclusion: In this real-world cohort of patients with a first hospitalization for an ACS, the use of an early invasive treatment strategy was associated with a lower risk for cardiac death and rehospitalization for MI compared with a conservative invasive approach. Primary Funding Source: Department of Cardiology, University Hospital Gentofte.

U2 - 10.7326/M15-0303

DO - 10.7326/M15-0303

M3 - Journal article

C2 - 26502223

SN - 0003-4819

VL - 163

SP - 737

EP - 746

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

IS - 10

ER -

Effectiveness of an Early Versus Conservative Invasive Treatment Strategy in Acute Coronary Syndromes: A Nationwide Cohort Study

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