TCT-148 An international analyses of 122,610 NSTEMI patients with 5 year outcomes: assessing the influence of age and comorbidities on invasively vs medically managed patients between 2004 and 2014.

Protty, Majd; Al-zuhairi, Karam; Kinnaird, Tim; Mamas, Mamas; Torp-Pedersen, Christian; Smith, Dave; Freeman, Philip

Abstract

NSTEMI patients are at risk of death, reinfarction and ischaemia, a risk that increases as cardiovascular risk (GRACE) increases. However, data from UK national registries identifies at least 60,000 NSTEMI patients per year not receiving an invasive strategy. The majority of these patients are elderly with multiple comorbities and high (GRACE) risk. Very few of the trials that shape our guidelines include elderly high risk patients. We investigate the influence of age and comorbidity on the long-term outcomes of these patients on a large population level.

Methods
We used (non-billing) academic national databases in Denmark and Wales (UK) that capture all disease events in hospitals using a secured and anonymized system. We selected all patients with a first diagnosis of NSTEMI between 2004-2014. Subjects were identified and validated by a combination of ICD-10 codes, operation codes, and linkage to coronary angiography data. Propensity matching and cox regression analysis to show the adjusted effects of invasive strategy (inv) versus medical strategy (med) only.

Results
Study population of DK was double that of Wales throughout the study period (6 million vs 3 million). There were a total of 122,610 NSTEACS patients (64,646 DK and 57,964 Wales). A total of 60,138 received inv strategy (39,717 (61.4%) DK and 20,421 (35.2%) Wales) and a total of 62,472 received just med therapy (24,929 DK and 37,543 Wales). Most comorbidities in both Inv and Med arms had double the prevalence in the Welsh population. After propensity matching for baseline characteristics between med and inv groups in each country the higher frequency of comorbidities in the UK population continued to be reflected. In both countries both the composite and individual endpoints of net adverse cardiac events plus heart failure were significantly improved for the invasively managed patients at both one and five years.

Conclusion
The frequency of first time NSTEMI in Wales is double that of Denmark, almost all major comorbidities have twice the prevalence in Wales also. Despite the higher frequency of comorbidities in the UK population a reduction in all endpoints is preserved in the older higher risk and comorbid invasive group.

Citation

Protty, M., Al-zuhairi, K., Kinnaird, T., Mamas, M., Torp-Pedersen, C., Smith, D., & Freeman, P. (2018, September). TCT-148 An international analyses of 122,610 NSTEMI patients with 5 year outcomes: assessing the influence of age and comorbidities on invasively vs medically managed patients between 2004 and 2014. Poster presented at Thirtieth Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT), San Diego, CA, USA

• Presentation Conference Type: Poster
• Conference Name: Thirtieth Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT)
• Conference Location: San Diego, CA, USA
• Start Date: Sep 21, 2018
• End Date: Sep 25, 2018
• Deposit Date: Jun 20, 2023
• Publisher: Elsevier
• DOI: https://doi.org/10.1016/j.jacc.2018.08.1256
• Keywords: Cardiology and Cardiovascular Medicine
• Additional Information: This article is maintained by: Elsevier; Article Title: TCT-148 An international analyses of 122,610 NSTEMI patients with 5 year outcomes: assessing the influence of age and comorbidities on invasively vs medically managed patients between 2004 and 2014.; Journal Title: Journal of the American College of Cardiology; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.jacc.2018.08.1256; Content Type: simple-article; Copyright: Copyright © 2018 Published by Elsevier Inc.