Journal
ARQUIVOS BRASILEIROS DE CARDIOLOGIA
Volume 120, Issue 5, Pages -Publisher
ARQUIVOS BRASILEIROS CARDIOLOGIA
DOI: 10.36660/abc.20220849
Keywords
Acute Coronary Syndrome; Mortality; Survival Analysis; Angioplasty; Coronary Artery Bypass
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In this study, the impact of three therapeutic strategies (medical therapy alone, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG)) on long-term survival of ACS patients was evaluated. The results showed that compared to patients receiving medical therapy alone, those who underwent PCI had a lower probability of fatal events during the four-year follow-up period.
Background: Relationship between reperfusion therapy post-acute coronary syndrome (ACS) and mortality in secondary care is not well-known.Objectives: To evaluate the impact of three therapeutic strategies: (1) medical therapy alone, (2) percutaneous coronary intervention (PCI) and (3) coronary artery bypass grafting (CABG) on long-term survival of participants in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study.Methods: Survival analyses for all-cause, cardiovascular (CVD) and coronary artery disease (CAD) mortality were performed according to three therapeutic strategies (exclusive medical therapy, PCI or CABG). Cox regression models were used to estimate the hazard ratio (HR) with respective 95% confidence interval (95%CI) from 180 days to four years of follow-up after ACS. Models are presented as crude, age-sex adjusted and further adjusted for previous CAD, ACS subtype, smoking, hypertension, dyslipidemia, left ventricular ejection fraction and according to the number of obstructed (& GE; 50%) major coronary arteries.Results: Among 800 participants, the lowest crude survival rates were detected among individuals who underwent CABG (all-cause and CVD). CABG was correlated to CAD (HR: 2.19 [95% CI: 1.05-4.55]). However, this risk lost significance in the full model. PCI was associated to lower probability of fatal events during four-year follow-up: all-cause [multivariate HR: 0.42 (95% CI: 0.26-0.70)], CVD [HR: 0.39 (95% CI: 0.20-0.73)] and CAD [multivariate HR: 0.24 (95% CI: 0.09-0.63)] compared to those submitted to medical therapy alone.Conclusion: In the ERICO study, PCI after ACS was associated to better prognosis, particularly CAD survival.
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