„

„

Long-term mortality of guideline

Long-term mortality of guideline

based earl conservative strategy in

based earl conservative strategy in

Acute Coronary Syndome populaton”

Acute Coronary Syndome populaton”

Authors

Authors

: Jarosław Zalewski, Krzysztof Nycz, Anna

: Jarosław Zalewski, Krzysztof Nycz, Anna

Gołaś, Monika Durak, Krzysztof Żmudka

Gołaś, Monika Durak, Krzysztof Żmudka

Department of Hemodynamics and

Department of Hemodynamics and

Angiocadiography, Institute of Cardiology,

Angiocadiography, Institute of Cardiology,

Collegium Medicum, Jagiellonian

Collegium Medicum, Jagiellonian

University, John Paul II Hospital, Kakow,

University, John Paul II Hospital, Kakow,

Poland

Poland

NSTEMI - TIMI risk score

 age > 65 yrs
 3 or more CAD Risk

Factors

 exacerbation of

clinical smpthoms

 ST segment

depression in ECG

 elevation of cardiac

markers

 ASA in-take in last 7

dys

 known relevant

stenosis of coronary
arteries

ESC/AHA/ACC indications for interventional

treatment of STEMI patients:



pain duration <= 12 hrs



ST segment elevtion (>= 2mm, in > 2 leads)



pulse on peripheral arteries

Indications for PCI of patients with cardiogenic

shock:



time from the onset of cardiac event < 36 hrs



time from the onset of cardiogenic shock < 18

hrs

Aims of the project:

Aims of the project:



to determine a long-term mortality in

to determine a long-term mortality in

patients with ACS primarly not

patients with ACS primarly not

eligible for invasive strategy of

eligible for invasive strategy of

treatment

treatment



to evaluate predictors of mortality in

to evaluate predictors of mortality in

patients with ACS primarly not

patients with ACS primarly not

eligible for invasive strategy of

eligible for invasive strategy of

treatment

treatment

Methods:

Methods:



retrospective analisis of patients with

retrospective analisis of patients with

ACS primarily not eligible for invasive

ACS primarily not eligible for invasive

treatment according to ESC/AHA/ACC

treatment according to ESC/AHA/ACC

guidelines in the year 2005 in the

guidelines in the year 2005 in the

median follow-up time of 24 months

median follow-up time of 24 months

(18-30 months)

(18-30 months)



study end-point: mortality

study end-point: mortality

In the year 2005:

In the year 2005:



1725 patients with ACS were refered to

1725 patients with ACS were refered to

Department of Hemodynamics and

Department of Hemodynamics and

Angiocardiography

Angiocardiography



1072 (62,1%) underwent PCI

1072 (62,1%) underwent PCI



529 (30,7%) were not eligible for PCI

529 (30,7%) were not eligible for PCI

•

252 (14,6%) were STEMI

252 (14,6%) were STEMI

•

277 (16,1%) were NSTEMI

277 (16,1%) were NSTEMI

Base-line chracteristic of study

population:

N

N

age

age

(

(

mean

mean

± SD) [

± SD) [

yrs

yrs

]

]

female

female

Risk Factors

Risk Factors

Hypertension

Hypertension

Diabetes Mellitus

Diabetes Mellitus

Pulmonary congestion (>1/3)

Pulmonary congestion (>1/3)

pulse (+) on femoral arteries

pulse (+) on femoral arteries

prior AMI

prior AMI

time of ischemia

time of ischemia

(

(

mesn

mesn

± SD)

± SD)

[h

[h

rs

rs

]

]

STEMI

STEMI

NSTEMI

NSTEMI

529

529

64

64

±

±

13

13

182 (34,75%)

182 (34,75%)

378 [71,5%]

378 [71,5%]

147 [27,8%]

147 [27,8%]

47 (8,9%)

47 (8,9%)

510 (96,5%)

510 (96,5%)

152 (28,8%)

152 (28,8%)

28,6

28,6

±

±

42,2

42,2

252 (47,6%)

252 (47,6%)

277 (52,4%)

277 (52,4%)

The reasons for excluding patients from catheter-

based reperfusion:

STEMI pts

STEMI pts

time of ischemia

time of ischemia

female >12

female >12

hrs

hrs

aborted STEMI

aborted STEMI

anticipated transport time

anticipated transport time

> 90’

> 90’

NSTEMI pts

NSTEMI pts

TIMI risk score <=4

TIMI risk score <=4

no patient consent

no patient consent

pulmonary oedema

pulmonary oedema

252

252

179 (71%)

179 (71%)

25 (10%)

25 (10%)

20 (8%)

20 (8%)

277

277

230 (83%)

230 (83%)

14 (5%)

14 (5%)

8 (3%)

8 (3%)

Krzywe Kaplana-Mayer’a nt smiertelnosci

Independent Risk Factors for mortality in STEMI pts

Independent Risk Factors for mortality in NSTEMI pts

Conclusion:

Conclusion:

The patinets with STEMI not eligible for

The patinets with STEMI not eligible for

catheter-based reperfusion constitute

catheter-based reperfusion constitute

population of the highest risk of long-

population of the highest risk of long-

term mortality.

term mortality.

The mortality rate in the whole non-PCI

The mortality rate in the whole non-PCI

ACS population depends on the Left

ACS population depends on the Left

Vantricualr Function as well as on the

Vantricualr Function as well as on the

performance of delayed PCI

performance of delayed PCI