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document
Timing of death and myocardial infarction in patients with non-ST elevation acute coronary syndromes : insights from randomized clinical trials . BACKGROUND Adverse events occur following non-ST elevation acute coronary syndromes ( NSTE ACS ) . However , the timing of these events in relation to index event is less clear . METHODS Accordingly , we evaluated 26,466 NSTE ACS patients from the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes ( GUSTO-IIb ) , Platelet Glycoprotein IIb/IIIa in Unstable Angina : Receptor Suppression Using Integrilin Therapy ( PURSUIT ) , and Platelet IIb/IIIa Antagonism for the Reduction of Acute Coronary Syndrome Events in a Global Organization Network ( PARAGON ) A and B trials to ascertain the timing of adverse events . Outcomes of interest were death , myocardial infarction ( MI ) , and death or MI at 180 days . Logistic regression modeling for death was used to categorize patients into low- , medium- , and high-risk groups . RESULTS At 6 months , 6.2 % of patients died , 12.1 % had MI , and 15.7 % suffered death or MI . From 15 % to 40 % of these events occurred beyond 30 days . At 6 months , 3 % , 4 % , and 13 % of patients died in low- , medium- , and high-risk groups , respectively . However , the proportion of patients dying beyond 30 days was similar in the three groups ( 44 % , 43 % , and 41 % of death , respectively ) . Similarly , whereas death or MI increased with higher risk ( 11 % , 14 % , and 23 % , respectively ) , the proportion of patients with this event beyond 30 days did not differ in the three strata ( 22 % , 20 % , and 25 % , respectively ) . CONCLUSIONS Our study provides important insights into the timing of adverse events and suggests that the substantial proportion of patients suffer subsequent adverse events after their index NSTE ACS . Thus , these data call for continuous surveillance for these events and efforts beyond the acute phase at increasing adherence to evidence-based therapies to improve the outcomes of these patients .
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Intervention_Pharmacological
Platelet Glycoprotein IIb/IIIa
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Intervention_Pharmacological
Receptor Suppression Using Integrilin Therapy
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Intervention_Educational
Logistic regression modeling
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Outcome_Mortality
Timing of death
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Outcome_Physical
myocardial infarction
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Outcome_Mortality
death
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Outcome_Physical
myocardial infarction ( MI )
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Outcome_Mortality
death
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Outcome_Physical
MI at 180 days
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Outcome_Mortality
died
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Outcome_Physical
MI
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Outcome_Mortality
death
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Outcome_Physical
MI
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Outcome_Mortality
proportion of patients dying
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Outcome_Mortality
death
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Participant_Condition
myocardial infarction
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Participant_Condition
acute coronary syndromes
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Participant_Condition
non-ST elevation acute coronary syndromes ( NSTE ACS ) .
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Participant_Sample-size
26,466