Does Early Invasive Treatment for ACS Lower Cardiac Risk?

A new study finds a link between early invasive treatment for acute coronary syndrome (ACS) and a lower short-term risk of adverse cardiac events, but authors caution that the results shouldn’t impact clinicians’ decision-making when determining whether to adopt an early invasive approach for ACS patients.

In an effort to investigate adverse cardiovascular outcomes of an early invasive strategy versus a more conservative invasive approach in a national cohort of patients with ACS, researchers used administrative healthcare data from the Danish national registries to study 19,704 propensity-score-matched patients hospitalized with a first ACS between Jan. 1, 2005 and Dec. 31, 2011. The authors measured risk for cardiac death or re-hospitalization for myocardial infarction (MI) within 60 days of hospitalization.
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The team found that adverse cardiac events took place much less frequently among patients who received early invasive treatment. More specifically, cardiac death occurred in 5.9% of patients in this group, in comparison to 7.6% of patients who were treated more conservatively. In addition, 3.4% of patients receiving early invasive treatment were re-hospitalized for MI, versus 5.0% of patients who received more conservative treatment.

Due to its observational design, the study is “not well-suited for informing the clinician which patients should receive an early invasive strategy when presenting with acute coronary syndrome,” notes Kim Wadt Hansen, MD, from University Hospital Bispebjerg, University of Copenhagen, and lead author of the study.

As such, the key message for primary care physicians should be that “adherence to the timeframes for treating patients presenting with acute coronary syndrome stated in current guidelines was associated with lower risk for adverse cardiac outcomes in a real-world setting,” says Hansen.

—Mark McGraw

Reference

Hansen K, Sorensen R, et al. Effectiveness of Early Invasive Treatment Strategies in ACS. Ann Intern Med. 2015.