An invasive strategy is associated with decreased mortality in patients with unstable angina and non-ST-elevation myocardial infarction: GUSTO IIb trial

Leslie Cho, Deepak L. Bhatt, Steve P. Marso, Danielle Brennan, David R. Holmes, Robert M. Califf, Eric J. Topol

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

PURPOSE: There has been much debate concerning an invasive versus a conservative strategy for patients with acute coronary syndromes. The purpose of this study was to determine whether early in-hospital catheterization reduced mortality in patients with unstable angina and non-ST-elevation myocardial infarction. METHODS: We performed a retrospective analysis of data collected in the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) IIb trial, which compared hirudin and heparin in patients with acute coronary syndromes. We identified 8011 patients with non-ST-segment elevation myocardial infarction and unstable angina who were enrolled in the trial. The primary endpoints were all-cause mortality at 30 days and 1 year. Data were analyzed with multivariate hazards models and propensity scores. RESULTS: After accounting for inception time bias, there were 7897 patients identified, of whom 4536 patients (57%) underwent invasive therapy and 3361 (43%) underwent conservative therapy. Adjusting for propensity scores, the adjusted 30-day mortality for the invasive group was 2.5% compared with 2.7% in the conservative group (P = 0.92); at 1 year, the invasive group had a 6.2% mortality, versus 8.6% in the conservative group (P = 0.005). In a multivariate analysis that adjusted for other clinical factors, an invasive strategy was associated with lower 1-year mortality (hazard ratio = 0.46; 95% confidence interval: 0.10 to 0.84). CONCLUSION: In patients presenting with acute coronary syndromes, an invasive strategy is associated with improved survival at 1 year even after adjusting for baseline differences.

Original languageEnglish (US)
Pages (from-to)106-111
Number of pages6
JournalAmerican Journal of Medicine
Volume114
Issue number2
DOIs
StatePublished - Feb 1 2003

Fingerprint

Unstable Angina
Mortality
Acute Coronary Syndrome
Propensity Score
Hirudins
Non-ST Elevated Myocardial Infarction
Proportional Hazards Models
Catheterization
Heparin
Coronary Vessels
Multivariate Analysis
Confidence Intervals
Survival

ASJC Scopus subject areas

  • Nursing(all)

Cite this

An invasive strategy is associated with decreased mortality in patients with unstable angina and non-ST-elevation myocardial infarction : GUSTO IIb trial. / Cho, Leslie; Bhatt, Deepak L.; Marso, Steve P.; Brennan, Danielle; Holmes, David R.; Califf, Robert M.; Topol, Eric J.

In: American Journal of Medicine, Vol. 114, No. 2, 01.02.2003, p. 106-111.

Research output: Contribution to journalArticle

Cho, Leslie ; Bhatt, Deepak L. ; Marso, Steve P. ; Brennan, Danielle ; Holmes, David R. ; Califf, Robert M. ; Topol, Eric J. / An invasive strategy is associated with decreased mortality in patients with unstable angina and non-ST-elevation myocardial infarction : GUSTO IIb trial. In: American Journal of Medicine. 2003 ; Vol. 114, No. 2. pp. 106-111.
@article{4180fd530c3d42a5b106b73b1f095cab,
title = "An invasive strategy is associated with decreased mortality in patients with unstable angina and non-ST-elevation myocardial infarction: GUSTO IIb trial",
abstract = "PURPOSE: There has been much debate concerning an invasive versus a conservative strategy for patients with acute coronary syndromes. The purpose of this study was to determine whether early in-hospital catheterization reduced mortality in patients with unstable angina and non-ST-elevation myocardial infarction. METHODS: We performed a retrospective analysis of data collected in the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) IIb trial, which compared hirudin and heparin in patients with acute coronary syndromes. We identified 8011 patients with non-ST-segment elevation myocardial infarction and unstable angina who were enrolled in the trial. The primary endpoints were all-cause mortality at 30 days and 1 year. Data were analyzed with multivariate hazards models and propensity scores. RESULTS: After accounting for inception time bias, there were 7897 patients identified, of whom 4536 patients (57{\%}) underwent invasive therapy and 3361 (43{\%}) underwent conservative therapy. Adjusting for propensity scores, the adjusted 30-day mortality for the invasive group was 2.5{\%} compared with 2.7{\%} in the conservative group (P = 0.92); at 1 year, the invasive group had a 6.2{\%} mortality, versus 8.6{\%} in the conservative group (P = 0.005). In a multivariate analysis that adjusted for other clinical factors, an invasive strategy was associated with lower 1-year mortality (hazard ratio = 0.46; 95{\%} confidence interval: 0.10 to 0.84). CONCLUSION: In patients presenting with acute coronary syndromes, an invasive strategy is associated with improved survival at 1 year even after adjusting for baseline differences.",
author = "Leslie Cho and Bhatt, {Deepak L.} and Marso, {Steve P.} and Danielle Brennan and Holmes, {David R.} and Califf, {Robert M.} and Topol, {Eric J.}",
year = "2003",
month = "2",
day = "1",
doi = "10.1016/S0002-9343(02)01446-8",
language = "English (US)",
volume = "114",
pages = "106--111",
journal = "American Journal of Medicine",
issn = "0002-9343",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - An invasive strategy is associated with decreased mortality in patients with unstable angina and non-ST-elevation myocardial infarction

T2 - GUSTO IIb trial

AU - Cho, Leslie

AU - Bhatt, Deepak L.

AU - Marso, Steve P.

AU - Brennan, Danielle

AU - Holmes, David R.

AU - Califf, Robert M.

AU - Topol, Eric J.

PY - 2003/2/1

Y1 - 2003/2/1

N2 - PURPOSE: There has been much debate concerning an invasive versus a conservative strategy for patients with acute coronary syndromes. The purpose of this study was to determine whether early in-hospital catheterization reduced mortality in patients with unstable angina and non-ST-elevation myocardial infarction. METHODS: We performed a retrospective analysis of data collected in the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) IIb trial, which compared hirudin and heparin in patients with acute coronary syndromes. We identified 8011 patients with non-ST-segment elevation myocardial infarction and unstable angina who were enrolled in the trial. The primary endpoints were all-cause mortality at 30 days and 1 year. Data were analyzed with multivariate hazards models and propensity scores. RESULTS: After accounting for inception time bias, there were 7897 patients identified, of whom 4536 patients (57%) underwent invasive therapy and 3361 (43%) underwent conservative therapy. Adjusting for propensity scores, the adjusted 30-day mortality for the invasive group was 2.5% compared with 2.7% in the conservative group (P = 0.92); at 1 year, the invasive group had a 6.2% mortality, versus 8.6% in the conservative group (P = 0.005). In a multivariate analysis that adjusted for other clinical factors, an invasive strategy was associated with lower 1-year mortality (hazard ratio = 0.46; 95% confidence interval: 0.10 to 0.84). CONCLUSION: In patients presenting with acute coronary syndromes, an invasive strategy is associated with improved survival at 1 year even after adjusting for baseline differences.

AB - PURPOSE: There has been much debate concerning an invasive versus a conservative strategy for patients with acute coronary syndromes. The purpose of this study was to determine whether early in-hospital catheterization reduced mortality in patients with unstable angina and non-ST-elevation myocardial infarction. METHODS: We performed a retrospective analysis of data collected in the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) IIb trial, which compared hirudin and heparin in patients with acute coronary syndromes. We identified 8011 patients with non-ST-segment elevation myocardial infarction and unstable angina who were enrolled in the trial. The primary endpoints were all-cause mortality at 30 days and 1 year. Data were analyzed with multivariate hazards models and propensity scores. RESULTS: After accounting for inception time bias, there were 7897 patients identified, of whom 4536 patients (57%) underwent invasive therapy and 3361 (43%) underwent conservative therapy. Adjusting for propensity scores, the adjusted 30-day mortality for the invasive group was 2.5% compared with 2.7% in the conservative group (P = 0.92); at 1 year, the invasive group had a 6.2% mortality, versus 8.6% in the conservative group (P = 0.005). In a multivariate analysis that adjusted for other clinical factors, an invasive strategy was associated with lower 1-year mortality (hazard ratio = 0.46; 95% confidence interval: 0.10 to 0.84). CONCLUSION: In patients presenting with acute coronary syndromes, an invasive strategy is associated with improved survival at 1 year even after adjusting for baseline differences.

UR - http://www.scopus.com/inward/record.url?scp=0037313462&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037313462&partnerID=8YFLogxK

U2 - 10.1016/S0002-9343(02)01446-8

DO - 10.1016/S0002-9343(02)01446-8

M3 - Article

C2 - 12586229

AN - SCOPUS:0037313462

VL - 114

SP - 106

EP - 111

JO - American Journal of Medicine

JF - American Journal of Medicine

SN - 0002-9343

IS - 2

ER -