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Regional Patterns o...
Regional Patterns of Use of a Medical Management Strategy for Patients With Non-ST-Segment Elevation Acute Coronary Syndromes : Insights From the EARLY ACS Trial
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Roe, Matthew T. (author)
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White, Jennifer A. (author)
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Kaul, Padma (author)
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Tricoci, Pierluigi (author)
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Lokhnygina, Yuliya (author)
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Miller, Chadwick D. (author)
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van't Hof, Arnoud W. (author)
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Montalescot, Gilles (author)
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- James, Stefan K., 1964- (author)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),kardiologi
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Saucedo, Jorge (author)
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Ohman, E. Magnus (author)
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Pollack, Charles V., Jr. (author)
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Hochman, Judith S. (author)
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Armstrong, Paul W. (author)
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Giugliano, Robert P. (author)
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Harrington, Robert A. (author)
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Van de Werf, Frans (author)
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Califf, Robert M. (author)
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Newby, L. Kristin (author)
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(creator_code:org_t)
- 2012
- 2012
- English.
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In: Circulation. Cardiovascular Quality and Outcomes. - 1941-7713 .- 1941-7705. ; 5:2, s. 205-213
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- Background: Regional differences in the profile and prognosis of non-ST-segment elevation acute coronary syndrome (NSTE ACS) patients treated with medical management after angiography remain uncertain.Methods and Results: Using data from the Early Glycoprotein IIb/IIIa Inhibition in Non-ST-Segment Elevation Acute Coronary Syndromes (EARLY ACS) trial, we examined regional variations in the use of an in-hospital medical management strategy in NSTE ACS patients who had significant coronary artery disease (CAD) identified during angiography, factors associated with the use of a medical management strategy, and 1-year mortality rates. Of 9406 patients, 8387 (89%) underwent angiography and had significant CAD; thereafter, 1766 (21%) were treated solely with a medical management strategy (range: 18% to 23% across 4 major geographic regions). Factors most strongly associated with a medical management strategy were negative baseline troponin values, prior coronary artery bypass grafting, lower baseline hemoglobin values, and greater number of diseased vessels; region was not a significant factor. One-year mortality was higher among patients treated with a medical management strategy compared with those who underwent revascularization (7.8% versus 3.6%; adjusted hazard ratio, 1.46; 95% CI, 1.21-1.76), with no significant interaction by region (interaction probability value=0.42).Conclusions: Approximately 20% of NSTE ACS patients with significant CAD in an international trial were treated solely with an in-hospital medical management strategy after early angiography, with no regional differences in factors associated with medical management or the risk of 1-year mortality. These findings have important implications for the conduct of future clinical trials, and highlight global similarities in the profile and prognosis of medically managed NSTE ACS patients.
Keyword
- non-ST-segment elevation acute coronary syndrome
- medical management
- coronary artery disease
- mortality
Publication and Content Type
- ref (subject category)
- art (subject category)
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Roe, Matthew T.
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White, Jennifer ...
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Kaul, Padma
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Tricoci, Pierlui ...
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Lokhnygina, Yuli ...
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Miller, Chadwick ...
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show more...
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van't Hof, Arnou ...
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Montalescot, Gil ...
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James, Stefan K. ...
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Saucedo, Jorge
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Ohman, E. Magnus
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Pollack, Charles ...
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Hochman, Judith ...
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Armstrong, Paul ...
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Giugliano, Rober ...
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Harrington, Robe ...
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Van de Werf, Fra ...
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Califf, Robert M ...
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Newby, L. Kristi ...
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Circulation. Car ...
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Uppsala University