Invasive vs. Conservative Therapy in Patients with Unstable Angina

pp 61-67

Abstract

Different drugs and revascularization procedures are available for the treatment of patients with unstable angina, although there is no consensus about which is the best therapeutic approach.Our purpose was to analyze, through a prospective registry, in-hospital evolution of patients admitted to conservative or invasive health centers. Health centers were classified according to the percentage of coronary angiographies performed in the conservative arm of the TIMI Illb trial. They were considered invasive if the rate of coronary angiographies was above 57% and conservative if it was below this rate. We included 206 patients at high risk of unstable angina, 90 (conservative group) entered to 8 conservative centers and 116 (invasive group) to 10 invasive institutions Baseline characteristics were similar except for previous myocardial revascularization procedures which number was greater in the invasive group(19% vs. 41% p < 0.000007). Patients were less frequently treated with heparin in the conservative group (46% vs. 71% p < 0.001).Coronary angiography was performed in 52% of the patients in the conservative group and in 78% of the invasive group (p < 0.0001). The high rate of patients systematically submitted to a coronary angiography in the invasive group -compared to the conservative group (60% vs. 34%)- shows a different behavior between both groups. During in-hospital evolution 13% of the patients in the conservative group and 17% in the invasive one exhibited refractory angina (p = NS), 6.6% and 4.3%respectively, suffered an acute myocardial infarction. Global mortality rate was 5.8% (6.6% in the conservative group and 5.1% in the invasive one (p = NS). The combined end point was similar be-tween both groups (26.6% vs. 26.7%). Our registry shows that a greater rate of interventions during hospitalization does not correlate with a better in-hospital evolution.