Angiography after non-ST-segment elevation MI linked with improved mortality


NEW YORK (Reuters Health), Oct 15 - Coronary angiography after non-ST-segment elevation myocardial infarction (NSTEMI) is associated with improved mortality across age, gender, and comorbidity groups, say U.K. researchers in the October Heart.

"Those at greatest risk have the most to gain," Dr. C. F. M. Weston from Swansea University, U.K., told Reuters Health by e-mail. "Don't deny higher risk patients the benefits of more aggressive intervention. Make a conscious effort to avoid discriminating on grounds of age or gender."

Dr. Weston and colleagues used Myocardial Ischemia National Audit Project data to study the effect of age, gender, and comorbidities on performance of angiography and intervention, along with subsequent outcomes, in more than 13,000 patients with NSTEMI.

The frequency of angiography was lower with increasing age (ranging from 84.3% in patients under 65 to 22.7% in those age 80 or older) and in women (46.7%) compared to men (65.2%), the authors report.

Least likely to have angiography were patients cared for by generalists (odds ratio, 0.75), those admitted to a noncardiac facility (OR, 0.85), those most socioeconomically deprived (OR, 0.76), and those with various comorbid conditions.

About a third of individuals with NSTEMI had coronary interventions during angiography, but as with the performance of angiography itself, the rates fell as age increased, from 63.3% in patients under 65 to 46.2% in patients age 80.

Compared to no angiography at all, angiography without intervention did not significantly improve the 180-day readmission rate. Angiography with an intervention was associated with a significantly reduced likelihood of readmission for men (hazard ratio, 0.67), but not for women (HR, 0.82).

The hazard ratio for death within 180 days was lower with angiography alone (HR, 0.59) and was reduced even further by any intervention (HR, 0.34), compared to no angiography at all.

Reductions in the risk of death were similar for men and women, the investigators say, and the impact of interventions on risk was seen across all age groups.

The risk of death was not different in patients having angiography electively or for symptoms.

Both noncardiac and cardiac comorbidities were associated with higher mortality, but the reduced risk of death associated with angiography and intervention was not significantly attenuated in the presence of either, according to the article.

"Clinicians should be made aware of the benefits that these patients can gain from interventions -- despite their co-morbidities," Dr. Weston concluded." General physicians (internal medicine specialists) should be ready to involve cardiologists in their management, and cardiologists should be prepared to play a part in the management of these patients -- even though interventions in this group might be less than straightforward."

By Will Boggs, M.D.

Heart 2009;95:1593-1599

Last Updated: 2009-10-14 18:18:40 -0400 (Reuters Health)

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