Recurrent angina after admission and invasive procedures use in NSTEACS – EPI-CARDIO

1. Recurrent angina after admission and invasive procedures use in NSTEACS – EPI-CARDIO Recurrent angina after admission may partially explain some discrepancies between initial risk stratification and the selection for invasive evaluation in Non ST Elevation Acute Coronary Syndromes. Results of the multicentre registry Epi-Cardio. www.epi-cardio.com.ar

2. Recurrent angina after admission and invasive procedures use in NSTEACS – EPI-CARDIO Background: -Data from observational studies has shown underuse of interventional procedures among high risk ACS patients and, paradoxically, a high rate of use in lower risk patients. -Moreover, some registries found an inverse relationship between risk (as defined by available risk scores) assessed at hospital admission and the rate of invasive procedures indication. www.epi-cardio.com.ar

3. Recurrent angina after admission and invasive procedures use in NSTEACS – EPI-CARDIO Background: -Among ACS patients, recurrence of ischemic symptoms at rest while receiving antithrombotic and anti-ischemic therapy, implies a very high risk of progession to myocardial infarction and death. -At the best of our knowledge, there are no studies evaluating the influence of in-hospital recurrent ischemic symptoms on the rate of interventional procedures utilization among ACS patients. www.epi-cardio.com.ar

4. Recurrent angina after admission and invasive procedures use in NSTEACS – EPI-CARDIO Methods: -We included patients with discharge diagnosis of NSTE-ACS (unstable angina and non-Q wave myocardial infarction), and complete data for analysis, included in the Epi-Cardio Registry from january to june 2.007. -Epi-Cardio is a prospective multicentre registry with 34 participating coronary units along Argentina. The data are entry to a computed discharge form that generates a database which is sent by e-mail for central statistical analysis. Consecutive entering is encouraged. www.epi-cardio.com.ar

5. Recurrent angina after admission and invasive procedures use in NSTEACS – EPI-CARDIO Methods: -Descriptive data are presented as mean (SD) and percentage, unless otherwise stated. -To assess the association between baseline characteristics and the use of an invasive strategy we conducted a univariate analysis. Variables with a p value < 0.05 were entered in a multivariate model. www.epi-cardio.com.ar

6. Recurrent angina after admission and invasive procedures use in NSTEACS – EPI-CARDIO Methods: -Dichotomic data were compared using chi square test, continuous data were compared using T test or Wilcoxon rank-sum test as appropiate. -Multivariate analysis was conducted using a logistic forward stepwise model. -Two tails p value of less than 0.05 was considered significant for all statistical analysis. www.epi-cardio.com.ar

7. Recurrent angina after admission and invasive procedures use in NSTEACS – EPI-CARDIO Results: -By june 2.007, 7.993 patients were included in the Epi-Cardio registry at 34 participating CCU. Of them, 739 had a discharge diagnosis of NSTE-ACS and complete available data and were included in the present study. www.epi-cardio.com.ar

8. Recurrent angina after admission and invasive procedures use in NSTEACS – EPI-CARDIO www.epi-cardio.com.ar

9. Recurrent angina after admission and invasive procedures use in NSTEACS – EPI-CARDIO www.epi-cardio.com.ar

10. Recurrent angina after admission and invasive procedures use in NSTEACS – EPI-CARDIO In-Hospital Treatment www.epi-cardio.com.ar

11. Recurrent angina after admission and invasive procedures use in NSTEACS – EPI-CARDIO In-Hospital events www.epi-cardio.com.ar

12. Recurrent angina after admission and invasive procedures use in NSTEACS – EPI-CARDIO Use of anti-thrombotic therapy and angiography by TIMI risk score group p<0.05 In-hospital therapy p<0.001 p<0.001 Patients (%) www.epi-cardio.com.ar

13. Recurrent angina after admission and invasive procedures use in NSTEACS – EPI-CARDIO Incidence of recurrent angina, death and the combined event by TIMI risk score group p<0.05 In-hospital events p<0.05 p<0.001 Patients (%) www.epi-cardio.com.ar

14. Recurrent angina after admission and invasive procedures use in NSTEACS – EPI-CARDIO Uni and multivariate factors associated with the use of coronary angiography during initial hospitalization www.epi-cardio.com.ar

15. Recurrent angina after admission and invasive procedures use in NSTEACS – EPI-CARDIO Use of invasive procedures in patients with recurrent symptoms according to TIMI risk score OR 13.4 (3-58) OR 3.8 (2.1-6.8) OR 1.8 (0.5-7) Patients (%) TIMI risk score www.epi-cardio.com.ar

16. Recurrent angina after admission and invasive procedures use in NSTEACS – EPI-CARDIO Conclusions: -Our results suggest that recurrent ischemic symptoms have a strong influence on the selection of patients with ACS for an invasive strategy. -The multivariate analysis showed that the presence of angiography facilities was also associated with the use of an invasive strategy, in addition to others clinical factors, stressing the complexity of making decision in ACS patients. www.epi-cardio.com.ar

17. Recurrent angina after admission and invasive procedures use in NSTEACS – EPI-CARDIO Conclusions: -Limitations: although the Epi-Cardio registry is multicentre and the investigators are encouraged to include consecutive patients we can not exclude that the presence of referral or selection bias could distort our results. www.epi-cardio.com.ar

18. Recurrent angina after admission and invasive procedures use in NSTEACS – EPI-CARDIO Conclusions: -Risk stratification of ACS patients is a dinamic and complex process that initiates with an early assessment, in which there are useful tools (baseline data, risks scores). However, considering treatments used in this population would be not complete if other factors, like in hospital response to therapy or hospital falicities are not take in count. www.epi-cardio.com.ar