Invasive treatment of NSTEMI patients in German chest pain units – evidence for a treatment paradox

  • Background: Patients with non ST-segment elevation myocardial infarction (NSTEMI) represent the largest fraction of patients with acute coronary syndrome in German Chest Pain units. Recent evidence on early vs. selective percutaneous coronary intervention (PCI) is ambiguous with respect to effects on mortality, myocardial infarction (MI) and recurrent angina. With the present study we sought to investigate the prognostic impact of PCI and its timing in German Chest Pain Unit (CPU) NSTEMI patients. Methods and results: Data from 1549 patients whose leading diagnosis was NSTEMI were retrieved from the German CPU registry for the interval between 3/2010 and 3/2014. Follow-up was available at median of 167 days after discharge. The patients were grouped into a higher (Group A) and lower risk group (Group B) according to GRACE score and additional criteria on admission. Group A had higher Killip classes, higher BNP levels, reduced EF and significant more triple vessel disease (p < 0.001). Surprisingly, patients in group A less frequently received early diagnostic catheterization and PCI. While conservative management did not affect prognosis in Group B, higher-risk CPU-NSTEMI patients without PCI had a significantly worse survival. Conclusions: The present results reveal a substantial treatment gap in higher-risk NSTEMI patients in German Chest Pain Units. This treatment paradox may worsen prognosis in patients who could derive the largest benefit from early revascularization.
Author:Frank Patrick Schmidt, Claus Schmitt, Matthias Hochadel, Evangelos Giannitsis, Harald Darius, Lars Siegfried Maier, Claus Schmitt, Gerd Heusch, Thomas VoigtländerORCiD, Harald Mudra, Tommaso Gori, Jochen Senges, Thomas MünzelORCiDGND
Pubmed Id:
Parent Title (English):International journal of cardiology
Publisher:Elsevier Science
Place of publication:Amsterdam [u. a.]
Document Type:Article
Year of Completion:2018
Date of first Publication:2018/02/03
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Contributing Corporation:German Chest Pain Unit Registry
Release Date:2018/11/27
Tag:Chest pain unit; Coronary intervention; NSTEMI; Prognosis
Page Number:5
First Page:15
Last Page:19
© 2017 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license (
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung-Nicht kommerziell - Keine Bearbeitung 4.0