Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/56130
Type: | Journal article |
Title: | Invasive management and late clinical outcomes in contemporary Australian management of acute coronary syndromes: observations from the ACACIA registry |
Author: | Chew, D. Amerena, J. Coverdale, S. Rankin, J. Astley, C. Soman, A. Brieger, D. Worthley, S. |
Citation: | Medical Journal of Australia, 2008; 188(12):691-697 |
Publisher: | Australasian Med Publ Co Ltd |
Issue Date: | 2008 |
ISSN: | 0025-729X |
Statement of Responsibility: | Derek P Chew, John V Amerena, Steve G Coverdale, Jamie M Rankin, Carolyn M Astley, Ashish Soman, David B Brieger...Worthley S... and on behalf of the ACACIA investigators |
Abstract: | OBJECTIVE: To describe the impact of invasive management on 12-month survival among patients with suspected acute coronary syndrome (ACS) in Australia. DESIGN AND SETTING: Prospective nationwide multicentre registry. PATIENTS: Patients presenting to 24 metropolitan and 15 non-metropolitan hospitals with ST-segment-elevation myocardial infarction (STEMI), and high-risk and intermediate-risk non-ST-segment-elevation ACS (NSTEACS) between 1 November 2005 and 31 July 2007. MAIN OUTCOME MEASURES: Death, myocardial infarction (MI) or recurrent MI, revascularisation and stroke at 12 months. RESULTS: Among 3402 patients originally enrolled, vital status at 12 months was available for 3393 (99.7%). Patients from non-metropolitan areas (810) constituted 23.9% of patients. Early invasive management was more commonly undertaken among patients with STEMI (STEMI, 89.7% v non-STEMI, 70.8% v unstable angina, 44.8% v stable angina, 35.8%; P<0.001). Factors most associated with receiving invasive management included admission with suspected STEMI or high-risk NSTEACS, being male and the hospital having an onsite cardiac surgical service. Overall mortality by 12 months among patients with STEMI, non-STEMI, unstable angina and stable angina was 8.0%, 10.5%, 3.3%, and 3.7% (P<0.001), respectively. After adjusting for a propensity model predicting early invasive management and other known confounders, early invasive management was associated with a 12-month mortality hazard ratio of 0.53 (95% CI, 0.34-0.84, P=0.007). CONCLUSIONS: A substantial burden of late morbidity and mortality persists among patients with ACS within contemporary Australian clinical practice. Under-use of invasive management may be associated with an excess in 12-month mortality, suggesting the need for more use of invasive management among these patients |
Description: | ©The Medical Journal of Australia 2008 |
Published version: | http://www.mja.com.au/public/issues/188_12_160608/che11258_fm.html |
Appears in Collections: | Aurora harvest Medicine publications |
Files in This Item:
There are no files associated with this item.
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.