• 1 National Heart Centre Singapore, Singapore. Electronic address:
  • 2 Sarawak General Hospital, Kuching, Malaysia
  • 3 Siriraj Hospital, Bangkok, Thailand
  • 4 Queen Mary Hospital, Hong Kong, SAR, China
  • 5 Sir Ganga Ram Hospital, New Delhi, India
  • 6 Seoul National University Hospital, Seoul, Republic of Korea
  • 7 Cardiovascular Science Research Centre, St George's University of London, UK
  • 8 Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Instituto de investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Spain; Universidad Complutense de Madrid, Spain
  • 9 London School of Hygiene and Tropical Medicine, London, UK
  • 10 Cho Ray Hospital, Ho Chi Minh City, Vietnam
  • 11 AstraZeneca, Madrid, Spain
  • 12 AstraZeneca, Osaka, Japan
  • 13 Peking University First Hospital, Beijing, China
Int J Cardiol, 2017 Sep 15;243:15-20.
PMID: 28747021 DOI: 10.1016/j.ijcard.2017.04.059


BACKGROUND: Many patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) are medically managed without coronary revascularization. The reasons vary and may impact prognosis.

METHODS: EPICOR Asia (NCT01361386) is a prospective study of hospital survivors post-ACS enrolled in 218 hospitals from 8 countries/regions in Asia (06/2011-05/2012). All medically managed NSTE-ACS patients were classified into 3 groups: 1) no coronary angiography (CAG-); 2) non-significant coronary artery disease (CAD) on angiogram (CAG+ CAD-); and 3) significant CAD (CAG+ CAD+). We compared baseline differences between patients medically managed and patients undergoing revascularization, and also between the medically managed groups. Adverse events were reported and compared up to 2years.

RESULTS: Of 6163 NSTE-ACS patients, 2272 (37%) were medically managed, with 1339 (59%), 254 (11%), and 679 (30%) in the CAG-, CAG+ CAD-, and CAG+ CAD+ groups, respectively. There were marked differences in the proportion of medically managed patients among the 8 countries/regions (13-81%). Medically managed patients had higher mortality at 2years compared with revascularization (8.7% vs. 3.0%, p<0.001). Among medically managed patients, CAG- patients were older, more likely to have pre-existing cardiovascular disease, and had the highest 2-year mortality (10.5% vs. 4.3% [CAG+ CAD-] and 6.6% [CAG+ CAD+], p<0.001). Mortality differences persisted after adjusting for other patient risk factors.

CONCLUSIONS: Medically managed NSTE-ACS patients are a heterogeneous group with different risk stratification and variable prognosis. Identification of reasons underlying different management strategies, and key factors adversely influencing long-term prognosis, may improve outcomes.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.