Cor Vasa 2014, 56(4):e369-e375 | DOI: 10.1016/j.crvasa.2014.05.005

Why some patients with acute coronary syndrome hospitalised in a university tertiary centre do not undergo coronary angiography? Results from the AHEAD ACS registry

Marián Felšöci^a,b,*, Mária Holická^a,d, Jiří Pařenica^a,b,d, Jiří Jarkovský^c, Roman Miklík^a,b, Kateřina Hořáková^a,d, Jindřich Špinar^a,b,d

^a Interní kardiologická klinika, Fakultní nemocnice Brno, Brno, Česká republika

^b Mezinárodní centrum klinického výzkumu, Fakultní nemocnice u sv. Anny v Brně, Brno, Česká republika

^c Institut biostatistiky a analýz Lékařské a Přírodovědecké fakulty Masarykovy univerzity, Brno, Česká republika

^d Lékařská fakulta Masarykovy univerzity, Brno, Česká republika

Aim of study: To evaluate in-hospital and long-term mortality of patients with acute coronary syndromes (ACS) not having in-hospital selective coronary angiography (SCA) and to analyze the reasons for conservative approach.
Method and patients: A single-center retrospective study using registry data. Over the period from January 2005 through April 2009, a total of 193 ACS patients did not have in-hospital SCA. Fifty-five (28.5%) patients were considered for SCA as a scheduled procedure and/or a recent angiographic finding was available (Group I), in 138 (71.5%) patients, SCA was not considered at all (Group K). The subgroups were to be compared in terms of in-hospital parameters and long-term mortality.

Results: ST-segment elevation myocardial infarction (STEMI) was diagnosed in 50 (25.9%) patients. The most frequent reasons for not performing SCA included prognostically serious comorbidities (22%) and pharmacological stabilization in very old individuals with non-STEMI (21%). One in ten (11%) patients died still before SCA, the same proportion of patients refused to have SCA or had a long ischemia time (STEMI subgroup). A temporary contraindication to SCA was found in 8%, a recent SCA finding not allowing revascularization was available in 8%, while a limiting neurological disease was present in 6% of patients. In-hospital mortality was 30.1%, being higher in Group K (34.1% vs. 20.0%; p = 0.049), 6-year mortality was as high as 78.8%, again with higher rates in Group K (86.2% vs. 60.2%; p < 0.001). Patients receiving conservative therapy were older, with a higher proportion of limiting comorbidities that excluded SCA, and a more serious course of hospitalization.

Conclusion: The most common reasons for not performing SCA in ACS include advanced age of patients, serious, often extracardiac comorbidities, and a complicated course of hospitalization, all factors adversely affecting prognosis. The short- and long-term mortality rates in these patients are high.

Keywords: Coronary angiography; Myocardial infarction; Prognosis

Received: April 30, 2014; Accepted: May 28, 2014; Published: August 1, 2014  Show citation