Recurrent ischemia across the spectrum of acute coronary syndromes: Prevalence and prognostic significance of (Re-)infarction and ST-segment changes in a large contemporary registry
Identifieur interne : 007594 ( Main/Exploration ); précédent : 007593; suivant : 007595Recurrent ischemia across the spectrum of acute coronary syndromes: Prevalence and prognostic significance of (Re-)infarction and ST-segment changes in a large contemporary registry
Auteurs : Andrew T. Yan [Canada] ; Philippe Gabriel Steg [France] ; Gordon Fitzgerald [États-Unis] ; Laurent J. Feldman [France] ; Kim A. Eagle [États-Unis] ; Joel M. Gore [États-Unis] ; Frederick A. Anderson [États-Unis] ; Jose Lopez-Sendon [Espagne] ; Enrique P. Gurfinkel [Argentine] ; David Brieger [Australie] ; Shaun G. Goodman [Canada]Source :
- International journal of cardiology [ 0167-5273 ] ; 2010.
Descripteurs français
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English descriptors
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Abstract
Background: There are limited recent data on the prevalence and potentially different adverse impact of the various types of recurrent ischemia (RI) in unselected patients with acute coronary syndromes(ACS). We examined the clinical features and treatment associated with, and the differential prognostic impact of, the various types of RI in unselected patients across the broad spectrum of ACS in the contemporary era. Methods: The Global Registry of Acute Coronary Events (GRACE) was a prospective, multinational registry of patients hospitalized for ACS. Data were collected on standardized case report forms. Results: Of the 29,400 ACS patients enrolled in May 2000-March 2007, 21% developed Rl; 2.4%, 4.9%, and 16% had myocardial (re-)infarction [(re-)MI], RI with ST-segment changes, and RI without ST-segment changes (not mutually exclusive), respectively. Rates of in-hospital mortality and complications, and 6-month mortality were significantly higher among patients with RI compared to those without; the rates were highest for patients who developed (re-)MI, followed by those with RI and ST-segment changes. After adjusting for other validated prognosticators in the GRACE risk score, all three types of RI retained an independent association with both higher in-hospital and post-discharge 6-month mortality. Early revascularization was associated with lower in-hospital mortality only in the group with (re-)MI (P for interaction = 0.003). Conclusions: Despite the current use of intensive medical therapies, RI remains a common and serious consequence across the spectrum of ACS. Different types of RI confer a variable adverse prognostic impact. Re-Ml is associated with the worst outcome, which appears to be mitigated by early revascularization. Our findings underscore the persistent need to improve the treatment of ACS.
Affiliations:
- Argentine, Australie, Canada, Espagne, France, États-Unis
- Communauté de Madrid, Nouvelle-Galles du Sud, Ontario, Île-de-France
- Madrid, Paris, Sydney, Toronto
- Université de Toronto
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Yan</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Gabriel Steg, Philippe" sort="Gabriel Steg, Philippe" uniqKey="Gabriel Steg P" first="Philippe" last="Gabriel Steg">Philippe Gabriel Steg</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Hôpital Bichat</s1><s2>Paris</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Fitzgerald, Gordon" sort="Fitzgerald, Gordon" uniqKey="Fitzgerald G" first="Gordon" last="Fitzgerald">Gordon Fitzgerald</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>University of Massachusetts Medical School</s1><s2>Worcester</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of Massachusetts Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Feldman, Laurent J" sort="Feldman, Laurent J" uniqKey="Feldman L" first="Laurent J." last="Feldman">Laurent J. 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Gore</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>University of Massachusetts Medical School</s1><s2>Worcester</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of Massachusetts Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Anderson, Frederick A" sort="Anderson, Frederick A" uniqKey="Anderson F" first="Frederick A." last="Anderson">Frederick A. Anderson</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>University of Massachusetts Medical School</s1><s2>Worcester</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of Massachusetts Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Lopez Sendon, Jose" sort="Lopez Sendon, Jose" uniqKey="Lopez Sendon J" first="Jose" last="Lopez-Sendon">Jose Lopez-Sendon</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Hospital Universitario La Paz</s1><s2>Madrid</s2><s3>ESP</s3><sZ>8 aut.</sZ></inist:fA14><country>Espagne</country><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Gurfinkel, Enrique P" sort="Gurfinkel, Enrique P" uniqKey="Gurfinkel E" first="Enrique P." last="Gurfinkel">Enrique P. Gurfinkel</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>ICYCC Favaloro Foundation</s1><s2>Buenos Aires</s2><s3>ARG</s3><sZ>9 aut.</sZ></inist:fA14><country>Argentine</country><wicri:noRegion>ICYCC Favaloro Foundation</wicri:noRegion></affiliation></author><author><name sortKey="Brieger, David" sort="Brieger, David" uniqKey="Brieger D" first="David" last="Brieger">David Brieger</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Concord Hospital</s1><s2>Sydney</s2><s3>AUS</s3><sZ>10 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Goodman, Shaun G" sort="Goodman, Shaun G" uniqKey="Goodman S" first="Shaun G." last="Goodman">Shaun G. Goodman</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">11-0022446</idno><date when="2010">2010</date><idno type="stanalyst">PASCAL 11-0022446 INIST</idno><idno type="RBID">Pascal:11-0022446</idno><idno type="wicri:Area/PascalFrancis/Corpus">002135</idno><idno type="wicri:Area/PascalFrancis/Curation">003D92</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">002091</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">002091</idno><idno type="wicri:doubleKey">0167-5273:2010:Yan A:recurrent:ischemia:across</idno><idno type="wicri:Area/Main/Merge">007B59</idno><idno type="wicri:Area/Main/Curation">007594</idno><idno type="wicri:Area/Main/Exploration">007594</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Recurrent ischemia across the spectrum of acute coronary syndromes: Prevalence and prognostic significance of (Re-)infarction and ST-segment changes in a large contemporary registry</title><author><name sortKey="Yan, Andrew T" sort="Yan, Andrew T" uniqKey="Yan A" first="Andrew T." last="Yan">Andrew T. Yan</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Gabriel Steg, Philippe" sort="Gabriel Steg, Philippe" uniqKey="Gabriel Steg P" first="Philippe" last="Gabriel Steg">Philippe Gabriel Steg</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Hôpital Bichat</s1><s2>Paris</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Fitzgerald, Gordon" sort="Fitzgerald, Gordon" uniqKey="Fitzgerald G" first="Gordon" last="Fitzgerald">Gordon Fitzgerald</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>University of Massachusetts Medical School</s1><s2>Worcester</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of Massachusetts Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Feldman, Laurent J" sort="Feldman, Laurent J" uniqKey="Feldman L" first="Laurent J." last="Feldman">Laurent J. Feldman</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Hôpital Bichat</s1><s2>Paris</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Eagle, Kim A" sort="Eagle, Kim A" uniqKey="Eagle K" first="Kim A." last="Eagle">Kim A. Eagle</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>University of Michigan Health System</s1><s2>Ann Arbor</s2><s3>USA</s3><sZ>5 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of Michigan Health System</wicri:noRegion></affiliation></author><author><name sortKey="Gore, Joel M" sort="Gore, Joel M" uniqKey="Gore J" first="Joel M." last="Gore">Joel M. Gore</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>University of Massachusetts Medical School</s1><s2>Worcester</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of Massachusetts Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Anderson, Frederick A" sort="Anderson, Frederick A" uniqKey="Anderson F" first="Frederick A." last="Anderson">Frederick A. Anderson</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>University of Massachusetts Medical School</s1><s2>Worcester</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of Massachusetts Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Lopez Sendon, Jose" sort="Lopez Sendon, Jose" uniqKey="Lopez Sendon J" first="Jose" last="Lopez-Sendon">Jose Lopez-Sendon</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Hospital Universitario La Paz</s1><s2>Madrid</s2><s3>ESP</s3><sZ>8 aut.</sZ></inist:fA14><country>Espagne</country><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Gurfinkel, Enrique P" sort="Gurfinkel, Enrique P" uniqKey="Gurfinkel E" first="Enrique P." last="Gurfinkel">Enrique P. Gurfinkel</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>ICYCC Favaloro Foundation</s1><s2>Buenos Aires</s2><s3>ARG</s3><sZ>9 aut.</sZ></inist:fA14><country>Argentine</country><wicri:noRegion>ICYCC Favaloro Foundation</wicri:noRegion></affiliation></author><author><name sortKey="Brieger, David" sort="Brieger, David" uniqKey="Brieger D" first="David" last="Brieger">David Brieger</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Concord Hospital</s1><s2>Sydney</s2><s3>AUS</s3><sZ>10 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Goodman, Shaun G" sort="Goodman, Shaun G" uniqKey="Goodman S" first="Shaun G." last="Goodman">Shaun G. Goodman</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author></analytic><series><title level="j" type="main">International journal of cardiology</title><title level="j" type="abbreviated">Int. j. cardiol.</title><idno type="ISSN">0167-5273</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">International journal of cardiology</title><title level="j" type="abbreviated">Int. j. cardiol.</title><idno type="ISSN">0167-5273</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Acute coronary syndrome</term><term>Cardiology</term><term>Cardiovascular disease</term><term>Coronary heart disease</term><term>Ischemia</term><term>Myocardial infarction</term><term>Myocardium</term><term>Prevalence</term><term>Prognosis</term><term>Recurrent</term><term>Relapse</term><term>ST change</term><term>ST interval</term><term>Variant angina</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Ischémie</term><term>Cardiopathie coronaire</term><term>Infarctus du myocarde</term><term>Angor instable</term><term>Pathologie de l'appareil circulatoire</term><term>Récidive</term><term>Récidivant</term><term>Prévalence</term><term>Pronostic</term><term>Myocarde</term><term>Intervalle ST</term><term>Décalage ST</term><term>Cardiologie</term><term>Syndrome coronaire aigu</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: There are limited recent data on the prevalence and potentially different adverse impact of the various types of recurrent ischemia (RI) in unselected patients with acute coronary syndromes(ACS). We examined the clinical features and treatment associated with, and the differential prognostic impact of, the various types of RI in unselected patients across the broad spectrum of ACS in the contemporary era. Methods: The Global Registry of Acute Coronary Events (GRACE) was a prospective, multinational registry of patients hospitalized for ACS. Data were collected on standardized case report forms. Results: Of the 29,400 ACS patients enrolled in May 2000-March 2007, 21% developed Rl; 2.4%, 4.9%, and 16% had myocardial (re-)infarction [(re-)MI], RI with ST-segment changes, and RI without ST-segment changes (not mutually exclusive), respectively. Rates of in-hospital mortality and complications, and 6-month mortality were significantly higher among patients with RI compared to those without; the rates were highest for patients who developed (re-)MI, followed by those with RI and ST-segment changes. After adjusting for other validated prognosticators in the GRACE risk score, all three types of RI retained an independent association with both higher in-hospital and post-discharge 6-month mortality. Early revascularization was associated with lower in-hospital mortality only in the group with (re-)MI (P for interaction = 0.003). Conclusions: Despite the current use of intensive medical therapies, RI remains a common and serious consequence across the spectrum of ACS. Different types of RI confer a variable adverse prognostic impact. Re-Ml is associated with the worst outcome, which appears to be mitigated by early revascularization. Our findings underscore the persistent need to improve the treatment of ACS.</div></front></TEI><affiliations><list><country><li>Argentine</li><li>Australie</li><li>Canada</li><li>Espagne</li><li>France</li><li>États-Unis</li></country><region><li>Communauté de Madrid</li><li>Nouvelle-Galles du Sud</li><li>Ontario</li><li>Île-de-France</li></region><settlement><li>Madrid</li><li>Paris</li><li>Sydney</li><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><country name="Canada"><region name="Ontario"><name sortKey="Yan, Andrew T" sort="Yan, Andrew T" uniqKey="Yan A" first="Andrew T." last="Yan">Andrew T. Yan</name></region><name sortKey="Goodman, Shaun G" sort="Goodman, Shaun G" uniqKey="Goodman S" first="Shaun G." last="Goodman">Shaun G. Goodman</name></country><country name="France"><region name="Île-de-France"><name sortKey="Gabriel Steg, Philippe" sort="Gabriel Steg, Philippe" uniqKey="Gabriel Steg P" first="Philippe" last="Gabriel Steg">Philippe Gabriel Steg</name></region><name sortKey="Feldman, Laurent J" sort="Feldman, Laurent J" uniqKey="Feldman L" first="Laurent J." last="Feldman">Laurent J. Feldman</name></country><country name="États-Unis"><noRegion><name sortKey="Fitzgerald, Gordon" sort="Fitzgerald, Gordon" uniqKey="Fitzgerald G" first="Gordon" last="Fitzgerald">Gordon Fitzgerald</name></noRegion><name sortKey="Anderson, Frederick A" sort="Anderson, Frederick A" uniqKey="Anderson F" first="Frederick A." last="Anderson">Frederick A. Anderson</name><name sortKey="Eagle, Kim A" sort="Eagle, Kim A" uniqKey="Eagle K" first="Kim A." last="Eagle">Kim A. Eagle</name><name sortKey="Gore, Joel M" sort="Gore, Joel M" uniqKey="Gore J" first="Joel M." last="Gore">Joel M. Gore</name></country><country name="Espagne"><region name="Communauté de Madrid"><name sortKey="Lopez Sendon, Jose" sort="Lopez Sendon, Jose" uniqKey="Lopez Sendon J" first="Jose" last="Lopez-Sendon">Jose Lopez-Sendon</name></region></country><country name="Argentine"><noRegion><name sortKey="Gurfinkel, Enrique P" sort="Gurfinkel, Enrique P" uniqKey="Gurfinkel E" first="Enrique P." last="Gurfinkel">Enrique P. Gurfinkel</name></noRegion></country><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Brieger, David" sort="Brieger, David" uniqKey="Brieger D" first="David" last="Brieger">David Brieger</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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