Aggressive therapy for non-ST elevation acute coronary syndromes is highly effective

Background

Therapeutic approach of non-ST-elevation acute coronary syndrome with glycoprotein IIb/IIIa inhibitors and early coronary angiography (CA) with immediate angioplasty (ACTP), when feasible, has been proposed as a very effective strategy.

Objectives

To review demographic data, risk factors, myocardial necrosis markers, C-reactive protein, clinical stabilization with therapy and in-hospital outcome of patients admitted due to unstable angina (UA) or non-Q-wave acute myocardial infarction (nQwAMI).

Materials and method

Retrospective analysis was conducted of 43 consecutive patients, 70% of whom were male, mean age 65 ± 13 years, 54% with UA and 46% with nQwAMI. Student's t test and Kruskal-Wallis (KW) tests were used.

Results

There was a higher prevalence of UA among men (63%) and of nQwAMI among women (69%; P = 0.05). Braunwald's classIIIB2 was recognized in 86% of the UA group. From the nQwAMI group, 38% were Killip class >1. There were no differences in risk factors, except for the presence of hyperlipidemia (UA 74% versus nQwAMI 38%; P = 0.02). Major interventions are summarized in the Table.

Table

Abciximab was used in 15% of patients (UA 66%, nQwAMI 34%). In-hospital outcomes are as follows: mean length of stay, UA 6 ± 5 days, nQwAMI 7 ± 7 days. Of UA patients 13% evolved to AMI. Two deaths occurred (one UA patient and one nQwAMI patient). Median CKMB mass and cardiac troponin were higher in nQwAMI group (10 versus 1.5 and 0.9 versus 0.5, respectively, and both P < 0.001 KW). No difference in C-reactive protein was detected.

Conclusion

Aggressive therapy for non-ST-elevation acute coronary syndromes combining abciximab, early angiography and angioplasty with stents resulted in a favorable in-hospital outcome in high-risk patients, with a short length of stay.