P4592Trends in prognosis and management of acute coronary syndromes using combined bleeding and ischaemic risk assessment - a retrospective analysis of MINAP data

Mohamed, M O; Kinnaird, T; Kwok, C S; Rashid, M; Anderson, R; Martin, G; Zaman, A; Mamas, M A

Abstract

Background: Patients presenting with acute coronary syndrome (ACS) represent a heterogeneous population with various risk factors for coronary ischaemia and bleeding. Current ESC guidelines recommend potent dual antiplatelet therapy (DAPT), and cardiac catheterisation for high-risk NSTEMI and all STEMI patients. The overlap of risk factors leading to further ischaemia and bleeding, cardiologists frequently face a challenge of managing patients with dual high risk.

Purpose: We sought to examine the trends in survival and adverse outcomes in ACS across all GRACE and CRUSADE risk combinations and evaluate the difference in standard of care received across these groups.

Methods: A retrospective observational analysis of the MINAP database was performed for all ACS (STEMI, NSTEMI, and UA) patients admitted to three regional centres in England from January 2010 to March 2016. Patients were classified into 9 groups for analysis as this represented all possible permutations of combined CRUSADE and GRACE risk profiles (key in Figure 1). Group 1 (Low CRUSADE-Low GRACE) was the reference group in multiple logistic regression. All odds ratios are adjusted and presented as OR[95% confidence interval, p-value].

Results: A total of 15578 patients (mean age 65.7±13.1 years, 71.6% males, 51.3% STEMI) were included in the analysis. In-hospital MACE, all-cause death, and 30-day mortality were highest in Group 9, followed by Group 6 and Group 3 (Figure 2a). This remains statistically significant in the multivariate analysis. The highest all-cause bleeding rates were observed in Group 3, Group 6 and Group 9 (Figure 2a). However, Group 9 and Group 3 were the only statistically significant predictors of bleeding.

Group 9 demonstrated significantly higher in-hospital major acute cardiovascular events (MACE, a composite of in-hospital cardiac death, in-hospital all-cause bleeding, and re-infarction) (OR 5.4 [3.1,9.5],p<0.001), all-cause mortality (OR 15.9 [5.0,50.6],p<0.001), all-cause bleeding (OR 8.0 [2.5,25.9],p=0.001) and 30-day mortality (OR17.8 [5.6,56.7],p<0.001) than all other risk groups. Interestingly, this group was the least likely to be offered coronary angiography (OR 0.43 [0.35,0.53],p<0.001) and DAPT (OR 0.29 [0.22,0.38],p<0.001) contrary to current guideline recommendations (Figure 2b).

Citation

Mohamed, M. O., Kinnaird, T., Kwok, C. S., Rashid, M., Anderson, R., Martin, G., Zaman, A., & Mamas, M. A. P4592Trends in prognosis and management of acute coronary syndromes using combined bleeding and ischaemic risk assessment - a retrospective analysis of MINAP data

• Presentation Conference Type: Conference Paper (published)
• Online Publication Date: Aug 28, 2018
• Publication Date: Aug 1, 2018
• Deposit Date: Jun 28, 2023
• Journal: European Heart Journal
• Print ISSN: 0195-668X
• Electronic ISSN: 1522-9645
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 39
• Issue: suppl_1
• DOI: https://doi.org/10.1093/eurheartj/ehy563.p4592
• Keywords: Cardiology and Cardiovascular Medicine; acute coronary syndromes; ischemia; hemorrhage; risk assessment
• Public URL: https://keele-repository.worktribe.com/output/510273