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Timing of coronary ...
Timing of coronary angiography in patients with non-ST-elevation acute coronary syndrome : long-term clinical outcomes from the nationwide SWEDEHEART registry
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- Eggers, Kai M., 1962- (författare)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi
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- James, Stefan, 1964- (författare)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi
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- Jernberg, Tomas (författare)
- Karolinska Institutet
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- Lindahl, Bertil, 1957- (författare)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi
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(creator_code:org_t)
- Europa Digital & Publishing, 2022
- 2022
- Engelska.
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Ingår i: EuroIntervention. - : Europa Digital & Publishing. - 1774-024X .- 1969-6213. ; 18:7, s. 582-589
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.4...
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http://kipublication...
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Abstract
Ämnesord
Stäng
- Background: Current guidelines stress the importance of early invasive assessment of patients with non -ST-elevation acute coronary syndrome (NSTE-ACS), in particular those at high risk. However, supporting scientific evidence is limited. Aims: We aimed to investigate the prognostic impact of the timing of coronary angiography in a large cohort of NSTE-ACS patients. Methods: We performed a retrospective analysis including 34,666 NSTE-ACS patients registered from 2013 to 2018 in the SWEDEHEART registry. The prognostic implications of the timing of coronary angi-ography on a continuous scale and within <24 vs 24-72 hours were assessed using Cox regression analyses. Results: The median time interval from admission to invasive assessment was 32.8 (25th, 75th percentiles 20.4-63.8) hours. There was no apparent time window within 96 hours from admission that provided prog-nostic benefit. Coronary angiography within 24-72 hours (vs <24 hours) was not associated with worse out-come overall (all-cause mortality: hazard ratio 1.01, 95% confidence interval [CI] 0.92-1.11; major adverse events: hazard ratio 1.04, 95% CI: 0.98-1.12). Interaction analyses indicated a greater relative benefit of coronary angiography <24 hours in some lower-risk groups (women, non-diabetics, patients with minor tro-ponin elevation) but neutral effects in higher-risk groups (defined by age or the GRACE 2.0 score). Conclusions: These Swedish data do not provide support for an early invasive strategy in NSTE-ACS, especially in high-risk patients. Our results suggest that the timing of invasive assessment should rather be based on individualised decisions integrating symptoms and risk panorama than on strictly defined time intervals.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Nyckelord
- ACS
- NSTE-ACS
- clinical research
- NSTEMI
- risk stratification
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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