Effectiveness of an Early Versus Conservative Invasive Treatment Strategy in Acute Coronary Syndromes: A Nationwide Cohort Study
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Effectiveness of an Early Versus Conservative Invasive Treatment Strategy in Acute Coronary Syndromes : A Nationwide Cohort Study. / Hansen, Kim Wadt; Sorensen, Rikke; Madsen, Mette; Madsen, Jan Kyst; Jensen, Jan Skov; von Kappelgaard, Lene Mia; Mortensen, Poul Erik; Lange, Theis; Galatius, Søren.
I: Annals of Internal Medicine, Bind 163, Nr. 10, 17.11.2015, s. 737-746.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Effectiveness of an Early Versus Conservative Invasive Treatment Strategy in Acute Coronary Syndromes
T2 - A Nationwide Cohort Study
AU - Hansen, Kim Wadt
AU - Sorensen, Rikke
AU - Madsen, Mette
AU - Madsen, Jan Kyst
AU - Jensen, Jan Skov
AU - von Kappelgaard, Lene Mia
AU - Mortensen, Poul Erik
AU - Lange, Theis
AU - Galatius, Søren
PY - 2015/11/17
Y1 - 2015/11/17
N2 - Background: Randomized clinical trials have found that early invasive strategies reduce mortality, myocardial infarction (MI), and rehospitalization compared with a conservative invasive approach in acute coronary syndromes (ACSs), but the effectiveness of such strategies in real-world settings is unknown.Objective: To investigate adverse cardiovascular outcomes of an early versus conservative invasive strategy in a national cohort of patients with ACSs.Design: Retrospective cohort study.Setting: Administrative health care data on hospitalizations, procedures, and outcomes abstracted from the Danish national registries and covering all acute invasive procedures in patients presenting with an ACS.Patients: 19 704 propensity score-matched patients hospitalized with a first ACS between 1 January 2005 and 31 December 2011.Measurements: Risk for cardiac death or rehospitalization for MI within 60 days of hospitalization.Results: Compared with a conservative approach, early invasive strategies were associated with a lower risk for cardiac death (cumulative incidence, 5.9% vs. 7.6%; adjusted hazard ratio [HR], 0.75 [95% CI, 0.66 to 0.84]; P < 0.001). Similar results were found for rehospitalization for MI (cumulative incidence, 3.4% vs. 5.0%; adjusted odds ratio, 0.67 [CI, 0.58 to 0.77]; P < 0.001) and all-cause death (cumulative incidence, 7.3% vs. 10.6%; adjusted HR, 0.65 [CI, 0.59 to 0.72]; P < 0.001).Limitation: Potential residual confounding due to lack of core clinical variables.Conclusion: In this real-world cohort of patients with a first hospitalization for an ACS, the use of an early invasive treatment strategy was associated with a lower risk for cardiac death and rehospitalization for MI compared with a conservative invasive approach.Primary Funding Source: Department of Cardiology, University Hospital Gentofte.
AB - Background: Randomized clinical trials have found that early invasive strategies reduce mortality, myocardial infarction (MI), and rehospitalization compared with a conservative invasive approach in acute coronary syndromes (ACSs), but the effectiveness of such strategies in real-world settings is unknown.Objective: To investigate adverse cardiovascular outcomes of an early versus conservative invasive strategy in a national cohort of patients with ACSs.Design: Retrospective cohort study.Setting: Administrative health care data on hospitalizations, procedures, and outcomes abstracted from the Danish national registries and covering all acute invasive procedures in patients presenting with an ACS.Patients: 19 704 propensity score-matched patients hospitalized with a first ACS between 1 January 2005 and 31 December 2011.Measurements: Risk for cardiac death or rehospitalization for MI within 60 days of hospitalization.Results: Compared with a conservative approach, early invasive strategies were associated with a lower risk for cardiac death (cumulative incidence, 5.9% vs. 7.6%; adjusted hazard ratio [HR], 0.75 [95% CI, 0.66 to 0.84]; P < 0.001). Similar results were found for rehospitalization for MI (cumulative incidence, 3.4% vs. 5.0%; adjusted odds ratio, 0.67 [CI, 0.58 to 0.77]; P < 0.001) and all-cause death (cumulative incidence, 7.3% vs. 10.6%; adjusted HR, 0.65 [CI, 0.59 to 0.72]; P < 0.001).Limitation: Potential residual confounding due to lack of core clinical variables.Conclusion: In this real-world cohort of patients with a first hospitalization for an ACS, the use of an early invasive treatment strategy was associated with a lower risk for cardiac death and rehospitalization for MI compared with a conservative invasive approach.Primary Funding Source: Department of Cardiology, University Hospital Gentofte.
U2 - 10.7326/M15-0303
DO - 10.7326/M15-0303
M3 - Journal article
C2 - 26502223
VL - 163
SP - 737
EP - 746
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
SN - 0003-4819
IS - 10
ER -
ID: 147506799