TY  - JOUR
A1  - Schmidt, Frank Patrick
A1  - Schmitt, Claus
A1  - Hochadel, Matthias
A1  - Giannitsis, Evangelos
A1  - Darius, Harald
A1  - Maier, Lars Siegfried
A1  - Schmitt, Claus
A1  - Heusch, Gerd
A1  - Voigtländer, Thomas
A1  - Mudra, Harald
A1  - Gori, Tommaso
A1  - Senges, Jochen
A1  - Münzel, Thomas
T1  - Invasive treatment of NSTEMI patients in German chest pain units – evidence for a treatment paradox
T2  - International journal of cardiology
N2  - 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.
KW  - Chest pain unit
KW  - NSTEMI
KW  - Coronary intervention
KW  - Prognosis
Y1  - 2018
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/48354
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-483548
SN  - 1874-1754
SN  - 0167-5273
N1  - © 2017 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
VL  - 255
SP  - 15
EP  - 19
PB  - Elsevier Science
CY  - Amsterdam [u. a.]
ER  -