Revista Científica de la Sociedad Española de Medicina de Urgencias y Emergencias
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1er cuartil (4 de 32)
Emergency Medicine
Resumen
Original article
461-7
23
6
December
2011
461
467
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Clinical importance of early intensive medical treatment for improving prognosis in non-ST-elevation acute coronary syndrome
Fortuny E, Núñez Gil IJ, GarcÃa-Rubira JC, Ruiz Mateos B, Ibáñez B, Gonzalo N, Vivas D, Macaya C, Fernández Ortiz A
Unidad Coronaria. Servicio de Cardiología. Instituto Cardiovascular. Hospital Clínico San Carlos. Madrid, Spain.
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.
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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