Why some patients with acute coronary syndrome hospitalized in a university tertiary centre do not undergo coronary angiography? Results from the AHEAD-ACS registry

FELŠŐCI, Marián, M. HOLICKÁ, Jiří PAŘENICA, Jiří JARKOVSKÝ, Roman MIKLÍK, K. HOŘÁKOVÁ and Jindřich ŠPINAR. Why some patients with acute coronary syndrome hospitalized in a university tertiary centre do not undergo coronary angiography? Results from the AHEAD-ACS registry. Cor et Vasa. Brno: Česká kardiologická společnost, 2014, vol. 56, No 4, p. "e369"-"e375", 7 pp. ISSN 0010-8650. Available from: https://dx.doi.org/10.1016/j.crvasa.2014.05.005.

Basic information

• Original name: Why some patients with acute coronary syndrome hospitalized in a university tertiary centre do not undergo coronary angiography? Results from the AHEAD-ACS registry
• Authors: FELŠŐCI, Marián (703 Slovakia, guarantor, belonging to the institution), M. HOLICKÁ (203 Czech Republic), Jiří PAŘENICA (203 Czech Republic, belonging to the institution), Jiří JARKOVSKÝ (203 Czech Republic, belonging to the institution), Roman MIKLÍK (203 Czech Republic, belonging to the institution), K. HOŘÁKOVÁ (203 Czech Republic) and Jindřich ŠPINAR (203 Czech Republic, belonging to the institution).
• Edition: Cor et Vasa, Brno, Česká kardiologická společnost, 2014, 0010-8650.

Other information

• Original language: English
• Type of outcome: Article in a journal
• Field of Study: 30201 Cardiac and Cardiovascular systems
• Country of publisher: Czech Republic
• Confidentiality degree: is not subject to a state or trade secret
• RIV identification code: RIV/00216224:14110/14:00080045
• Organization unit: Faculty of Medicine
• Doi: http://dx.doi.org/10.1016/j.crvasa.2014.05.005
• UT WoS: 000409980600016
• Keywords in English: Acute heart failure; Coronary angiography; Myocardial infarction; Prognosis
• Tags: EL OK
• Tags: Reviewed

Abstract

Background To evaluate in-hospital and long-term mortality of patients with acute coronary syndromes (ACS) not having selective coronary angiography (CAG) during hospitalization and to analyze the reasons for conservative approach. Methods and patients A single-centre retrospective study using registry data. Over the period from January 2005 to April 2009, a total of 193 ACS patients did not have in-hospital CAG. Fifty-five (28.5%) patients had recent CAG (within the last 12 months) or the procedure was planned after discharge (invasive group "I"). In 138 (71.5%) patients, CAG was not considered at all (conservative approach, group "C"). These subgroups were compared in terms of in-hospital parameters and long-term mortality. Results ST-segment elevation myocardial infarction (STEMI) was diagnosed in 50 (25.9%) patients. The most frequent reasons for not performing CAG included serious comorbidities affecting the prognosis (22%) and pharmacological stabilization in very old individuals with non-STEMI (21%). One in ten (11%) patients died before the CAG was performed, the same proportion of patients refused to have CAG or had a long ischaemia time (STEMI subgroup). A temporary contraindication to CAG was found in 8%, a recent CAG finding not suitable for revascularization in 8%, while a limiting neurological disease was present in 6% of patients. In-hospital mortality was 30.1%, being higher in Group C (34.1% vs. 20.0%; p = 0.049), 6-year mortality was as high as 78.8%, also with higher rates in Group C (86.2% vs. 60.2%; p < 0.001). Patients receiving conservative therapy were older, with a higher proportion of limiting comorbidities that contraindicated CAG, and had a more serious course of hospitalization. Conclusion The most common reasons for not performing CAG in ACS patients included advanced age, serious and often extra-cardiac comorbidities, and a complicated hospitalization course. The short- and long-term mortality rates in these patients are high.