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dc.contributor.authorHinohara, Tomoya T
dc.contributor.authorRoe, Matthew T
dc.contributor.authorWhite, Harvey D
dc.contributor.authorFox, Keith A A
dc.contributor.authorBhatt, Deepak L
dc.contributor.authorHamm, Christian
dc.contributor.authorGurbel, Paul A
dc.contributor.authorAylward, Philip Edmund
dc.contributor.authorWiviott, Stephen D
dc.contributor.authorHuber, Kurt
dc.contributor.authorNeely, Megan
dc.contributor.authorOhman, E Magnus
dc.date.accessioned2018-11-01T05:32:33Z
dc.date.available2018-11-01T05:32:33Z
dc.date.issued2018-07-19
dc.identifier.citationHinohara, T. T., Roe, M. T., White, H. D., Fox, K. A. A., Bhatt, D. L., Hamm, C., … Ohman, E. M. (2018). Outcomes of Patients Receiving Downstream Revascularization After Initial Medical Management for Non–ST-Segment Elevation Acute Coronary Syndromes (From the TRILOGY ACS Trial). The American Journal of Cardiology, 122(8), 1322–1329.en_US
dc.identifier.issn1879-1913
dc.identifier.urihttp://hdl.handle.net/2328/38537
dc.description© 2018 Elsevier Inc. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. This author accepted manuscript is made available following 12 month embargo from date of publication (July 2018) in accordance with the publisher’s archiving policyen_US
dc.description.abstractPatients with non–ST-segment elevation acute coronary syndromes (NSTE ACS) are sometimes treated with medical management alone rather than an invasive strategy. Among those medically managed without revascularization and discharged, a proportion will require revascularization later on, but little is known about this population. In TRILOGY ACS, 9,326 patients with NSTE ACS who were selected for medical management alone were randomized to treatment with prasugrel or clopidogrel and discharged without revascularization. Patient characteristics and ischemic and bleeding outcomes through 30 months were compared between patients who underwent downstream revascularization after the index hospitalization and those who did not. A total of 662 patients (7.1%) underwent later revascularization by percutaneous coronary intervention (73.1%), coronary artery bypass graft surgery (26.4%), or the two (0.5%). Median time to revascularization was 121 days (twenty-fifth, seventy-fifth percentiles: 41, 326). Revascularized patients were younger, more likely to be male, and had higher rates of hyperlipidemia, diabetes mellitus, prior myocardial infarction, and prior revascularization compared with those not revascularized. Europe and North America had the highest rates of revascularization. During the follow-up period, those who underwent revascularization had a higher rate of the composite outcome of cardiovascular death, myocardial infarction, or stroke occurring after revascularization compared with those not revascularized (hazard ratio [HR] 2.73 [95% confidence interval {CI} 2.21 to 3.38], p < 0.001) as well as a higher rate of each of the individual outcomes. Major bleeding was also higher in those who underwent revascularization (GUSTO severe or life-threatening: HR 2.61 [95% CI 1.02 to 6.67], p = 0.045; TIMI major: HR 2.24 [95% CI 1.12 to 4.48], p = 0.022). There was no evidence that bleeding and ischemic outcomes varied by treatment with clopidogrel versus prasugrel. In conclusion, among patients initially medically managed after NSTE ACS, a small proportion later require revascularization and have a high rate of ischemic and major bleeding outcomes compared with those not requiring downstream revascularization.en_US
dc.description.sponsorshipSee article under heading of Disclosures.en_US
dc.language.isoenen_US
dc.publisherElsevieren_US
dc.rights© 2018 Elsevier Inc. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/en_US
dc.titleOutcomes of Patients Receiving Downstream Revascularization After Initial Medical Management for Non–ST-Segment Elevation Acute Coronary Syndromes (From the TRILOGY ACS Trial)en_US
dc.typeArticleen_US
dc.identifier.doihttps://doi.org/10.1016/j.amjcard.2018.06.052en_US
dc.rights.holder© 2018 Elsevier Inc.en_US
dc.rights.licenseCC-BY-NC-ND
local.contributor.authorOrcidLookupBhatt, Deepak L: https://orcid.org/0000-0002-1278-6245en_US


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