Open AccessDifferential Prognostic Effect of Revascularization According to a Simple Comorbidity Index in High‐Risk Non–ST‐Segment Elevation Acute Coronary Syndrome
Author(s) -
Palau Patricia,
Núñez Julio,
Sanchis Juan,
Husser Oliver,
Bodí Vicente,
Núñez Eduardo,
Miñana Gema,
Boesen Line,
Ventura Silvia,
Llàcer Angel
Publication year - 2012
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.20996
Subject(s) - medicine , revascularization , hazard ratio , cardiology , interquartile range , acute coronary syndrome , comorbidity , myocardial infarction , proportional hazards model , coronary artery disease , confidence interval , surgery
Background: Data on the effect of revascularization on outcome in patients with high‐risk non–ST‐segment elevation acute coronary syndrome (NSTEACS) and significant comorbidities are scarce. Recently, a simple comorbidity index (SCI) including 5 comorbidities (renal failure, dementia, peripheral artery disease, heart failure, and prior myocardial infarction [MI]) has shown to be a useful tool for risk stratification. Nevertheless, therapeutic implications have not been derived. Hypothesis: We sought to evaluate the prognostic effect attributable to revascularization in NSTEACS according the SCI score. Methods: We included 1017 consecutive patients with NSTEACS. The effect of revascularization on a combined end point of all‐cause mortality or nonfatal MI was evaluated by Cox regression according to SCI categories. Results: A total of 560 (55.1%), 236 (23.2%), and 221 (21.7%) patients showed 0, 1, and ≥2 points according to the SCI, respectively. Coronary angiography was performed in 725 patients (71.5%), and 450 patients (44.3%) underwent revascularization. During a median follow‐up of 16 months (interquartile range, 12–36 months), 305 (30%) patients experienced the combined end point (202 deaths [19.9%] and 170 MIs [16.7%]). In multivariate analysis, a differential prognostic effect of revascularization was observed comparing SCI ≥2 vs 0 ( P for interaction = 0.008). Thus, revascularization was associated with a greater prognostic benefit in patients with SCI ≥2 (hazard ratio [HR]: 0.51, 95% confidence interval [CI]: 0.29–0.89), P = 0.018), whereas no significant benefit was observed in those with 0 and 1 point (HR: 1.31, 95% CI: 0.88–1.94, P = 0.171 and HR: 1.11, 95% CI: 0.70–1.76, P = 0.651, respectively). Conclusions: In NSTEACS, the SCI score appears to be a useful tool for identifying a subset of patients with a significant long‐term death/MI risk reduction attributable to revascularization. © 2011 Wiley Periodicals, Inc. This study was supported by a grant from the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, RED HERACLES (FEDER) RD06/0009/1001 (Madrid, Spain). The authors have no other funding, financial relationships, or conflicts of interest to disclose.