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dc.contributor.author | Hall, Marlous | |
dc.contributor.author | Bebb, Owen | |
dc.contributor.author | Dondo, Tatandashe B | |
dc.contributor.author | Yan, Andrew T | |
dc.contributor.author | Goodman, Shaun G | |
dc.contributor.author | Bueno, Hector | |
dc.contributor.author | Chew, Derek P | |
dc.contributor.author | Brieger, David | |
dc.contributor.author | Batin, Philip D | |
dc.contributor.author | Farkouh, Michel E | |
dc.contributor.author | Hemingway, Harry | |
dc.contributor.author | Timmis, Adam | |
dc.contributor.author | Fox, Keith A A | |
dc.contributor.author | Gale, Chris P | |
dc.date.accessioned | 2019-02-11T14:00:21Z | |
dc.date.available | 2019-02-11T14:00:21Z | |
dc.date.issued | 2018-11-07 | |
dc.identifier.citation | Eur Heart J. 2018; 39(42):3798-3806 | es_ES |
dc.identifier.issn | 0195-668X | es_ES |
dc.identifier.uri | http://hdl.handle.net/20.500.12105/7165 | |
dc.description.abstract | Aims: To investigate whether improved survival from non-ST-elevation myocardial infarction (NSTEMI), according to GRACE risk score, was associated with guideline-indicated treatments and diagnostics, and persisted after hospital discharge. Methods and results: National cohort study (n = 389 507 patients, n = 232 hospitals, MINAP registry), 2003-2013. The primary outcome was adjusted all-cause survival estimated using flexible parametric survival modelling with time-varying covariates. Optimal care was defined as the receipt of all eligible treatments and was inversely related to risk status (defined by the GRACE risk score): 25.6% in low, 18.6% in intermediate, and 11.5% in high-risk NSTEMI. At 30 days, the use of optimal care was associated with improved survival among high [adjusted hazard ratio (aHR) -0.66 95% confidence interval (CI) 0.53-0.86, difference in absolute mortality rate (AMR) per 100 patients (AMR/100-0.19 95% CI -0.29 to -0.08)], and intermediate (aHR = 0.74, 95% CI 0.62-0.92; AMR/100 = -0.15, 95% CI -0.23 to -0.08) risk NSTEMI. At the end of follow-up (8.4 years, median 2.3 years), the significant association between the use of all eligible guideline-indicated treatments and improved survival remained only for high-risk NSTEMI (aHR = 0.66, 95% CI 0.50-0.96; AMR/100 = -0.03, 95% CI -0.06 to -0.01). For low-risk NSTEMI, there was no association between the use of optimal care and improved survival at 30 days (aHR = 0.92, 95% CI 0.69-1.38) and at 8.4 years (aHR = 0.71, 95% CI 0.39-3.74). Conclusion: Optimal use of guideline-indicated care for NSTEMI was associated with greater survival gains with increasing GRACE risk, but its use decreased with increasing GRACE risk. | es_ES |
dc.language.iso | eng | es_ES |
dc.publisher | Oxford University Press | es_ES |
dc.type.hasVersion | VoR | es_ES |
dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | * |
dc.title | Guideline-indicated treatments and diagnostics, GRACE risk score, and survival for non-ST elevation myocardial infarction | es_ES |
dc.type | journal article | es_ES |
dc.rights.license | Atribución 4.0 Internacional | * |
dc.identifier.pubmedID | 30202849 | es_ES |
dc.format.volume | 39 | es_ES |
dc.format.number | 42 | es_ES |
dc.format.page | 3798-3806 | es_ES |
dc.identifier.doi | 10.1093/eurheartj/ehy517 | es_ES |
dc.contributor.funder | British Heart Foundation | |
dc.description.peerreviewed | Sí | es_ES |
dc.identifier.e-issn | 1522-9645 | es_ES |
dc.identifier.journal | European heart journal | es_ES |
dc.repisalud.orgCNIC | CNIC::Grupos de investigación::Investigación Cardiovascular Traslacional Multidisciplinaria | es_ES |
dc.repisalud.institucion | CNIC | es_ES |
dc.rights.accessRights | open access | es_ES |