COMPARISON OF INVASIVE VERSUS MEDICAL STRATEGY OF PATIENTS WITH NON-ST ELEVATION MYOCARDIAL INFARCTION WITH INTERMEDIATE THROMBOLYSIS IN MYOCARDIAL INFARCTION SCORE

M SHOUKAT; AA SHAKEEL; N ULLAH; AE QURESHI; MN RAHI; T SHAFI

doi:10.54112/bcsrj.v2023i1.328

Authors

M SHOUKAT Department of Cardiology, Rehmatul-lil-Alameen Institute of Cardiology, PESSI, Lahore, Pakistan
AA SHAKEEL Department of Cardiology, Rehmatul-lil-Alameen Institute of Cardiology, PESSI, Lahore, Pakistan
N ULLAH Department of Cardiology, Rehmatul-lil-Alameen Institute of Cardiology, PESSI, Lahore, Pakistan
AE QURESHI Department of Cardiology, Rehmatul-lil-Alameen Institute of Cardiology, PESSI, Lahore, Pakistan
MN RAHI Department of Cardiology, Avicenna Hospital and Medical College, Lahore, Pakistan
T SHAFI Department of Cardiology, Hameed Latif Hospital Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2023i1.328

Keywords:

Score, Thrombolysis, Myocardial infarction, non-ST elevation, Medical strategy, Invasive, Outcome

Abstract

Non-ST-elevation myocardial infarction (NSTEMI) and unstable angina pectoris are frequent causes of hospital admission in the elderly. However, clinical trials targeting this population are scarce, making these patients less likely to receive treatment according to guidelines. This study was designed to compare the outcome of invasive versus a medical strategy of patients with non-ST elevation myocardial infarction with intermediate Thrombolysis in Myocardial Infarction score. This study was conducted at the Department of Cardiology, Rehmatul lil Alameen Institute of Cardiology, Lahore, from 21-5-2019 to 21-11-2019. A total of 220 (110 patients in each group) patients fulfilling inclusion criteria from emergencies were recruited. Then patients were randomly divided into two groups by using the lottery method. In group A, patients were managed through an invasive strategy. In group B, patients underwent medication only. Patients in the invasive strategy underwent percutaneous coronary intervention, or coronary artery bypass graft patients in the medical strategy group were given standard medical management per hospital protocol. Then patients were followed up there for 3 days. After 3 days, patients were discharged and were followed up in OPD for 30 days. It was noted if the patient presented again in an emergency with recurrent myocardial infarction (MI) or if death occurred within 30 days. This study compared an invasive and medical strategy in NSTEMI patients regarding recurrent MI and mortality within 30 days. According to the findings of this study, no significant difference was seen in recurrent MI (Group-A: 13.6% & Group-B: 12.7%, p-value=0.84) in both groups, but mortality (Group-A: 10.9% & Group-B: 3.6%, p-value=0.037) was significantly higher in patients who underwent invasive strategy. Considering the results of this study, it can be concluded that NSTEMI patients treated with conservative treatment had a low mortality rate and fewer chances of recurrent MI.

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References

Amsterdam, E. A., Wenger, N. K., Brindis, R. G., Casey Jr, D. E., Ganiats, T. G., Holmes Jr, D. R., Jaffe, A. S., Jneid, H., Kelly, R. F., and Kontos, M. C. (2014). 2014 AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 130, 2354-2394.

Boden, W. E. (2003). "Routine invasive" versus "selective invasive" approaches to non–ST-segment elevation acute coronary syndromes management in the post-stent/platelet inhibition era. Journal of the American College of Cardiology 41, S113-S122.

Cohen, M. (2016). Long-term outcomes in high-risk patients with non-ST-segment elevation myocardial infarction. Journal of thrombosis and thrombolysis 41, 464-474.

Fanning, J. P., Nyong, J., Scott, I. A., Aroney, C. N., and Walters, D. L. (2016). Routine invasive strategies versus selective invasive strategies for unstable angina and non‐ST elevation myocardial infarction in the stent era. Cochrane Database of Systematic Reviews.

Gnanenthiran, S. R., Kritharides, L., D'Souza, M., Lowe, H. C., and Brieger, D. B. (2017). Revascularisation compared with initial medical therapy for non-ST-elevation acute coronary syndromes in the elderly: a meta-analysis. Heart 103, 1962-1969.

Hung, C.-S., Chen, Y.-H., Huang, C.-C., Lin, M.-S., Yeh, C.-F., Li, H.-Y., and Kao, H.-L. (2018). Prevalence and outcome of patients with non-ST segment elevation myocardial infarction with occluded "culprit" artery–a systemic review and meta-analysis. Critical Care 22, 1-11.

Kolte, D., Khera, S., Palaniswamy, C., Mujib, M., Fonarow, G. C., Ahmed, A., Jain, D., Frishman, W. H., and Aronow, W. S. (2013). Early invasive versus initial conservative treatment strategies in octogenarians with UA/NSTEMI. The American Journal of Medicine 126, 1076-1083. e1.

Li, Y.-Q., Liu, N., and Lu, J.-H. (2014). Outcomes in patients with non-ST-elevation acute coronary syndrome randomly assigned to invasive versus conservative treatment strategies: a meta-analysis. Clinics 69, 398-404.

Prejean, S. P., Din, M., Reyes, E., and Hage, F. G. (2018). Guidelines in review: Comparison of the 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes and the 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Journal of Nuclear Cardiology 25, 769-776.

Sanchis, J., Núñez, E., Barrabés, J. A., Marín, F., Consuegra-Sánchez, L., Ventura, S., Valero, E., Roqué, M., Bayés-Genís, A., and Del Blanco, B. G. (2016). Randomized comparison between the invasive and conservative strategies in comorbid elderly patients with non-ST elevation myocardial infarction. European journal of internal medicine 35, 89-94.

Savonitto, S., Cavallini, C., Petronio, A. S., Murena, E., Antonicelli, R., Sacco, A., Steffenino, G., Bonechi, F., Mossuti, E., and Manari, A. (2012). Early aggressive versus initially conservative treatment in elderly patients with non–ST-segment elevation acute coronary syndrome: a randomized controlled trial. JACC: Cardiovascular Interventions 5, 906-916.

Tegn, N., Abdelnoor, M., Aaberge, L., Endresen, K., Smith, P., Aakhus, S., Gjertsen, E., Dahl-Hofseth, O., Ranhoff, A. H., and Gullestad, L. (2016). Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): an open-label randomised controlled trial. The lancet 387, 1057-1065.