Universität zu Köln

Ahrens, Ingo, Averkov, Oleg, Zuniga, Eduardo C., Fong, Alan Y. Y., Alhabib, Khalid F., Halvorsen, Sigrun, Kader, Muhamad A. B. S. K. Abdul, Sanz-Ruiz, Ricardo, Welsh, Robert, Yan, Hongbin and Aylward, Philip ORCID: 0000-0002-5358-8552 (2019). Invasive and antiplatelet treatment of patients with non-ST-segment elevation myocardial infarction: Understanding and addressing the global risk-treatment paradox. Clin. Cardiol., 42 (10). S. 1028 - 1041. HOBOKEN: WILEY. ISSN 1932-8737

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Abstract

Clinical guidelines for the treatment of patients with non-ST-segment elevation myocardial infarction (NSTEMI) recommend an invasive strategy with cardiac catheterization, revascularization when clinically appropriate, and initiation of dual antiplatelet therapy regardless of whether the patient receives revascularization. However, although patients with NSTEMI have a higher long-term mortality risk than patients with ST-segment elevation myocardial infarction (STEMI), they are often treated less aggressively; with those who have the highest ischemic risk often receiving the least aggressive treatment (the treatment-risk paradox). Here, using evidence gathered from across the world, we examine some reasons behind the suboptimal treatment of patients with NSTEMI, and recommend approaches to address this issue in order to improve the standard of healthcare for this group of patients. The challenges for the treatment of patients with NSTEMI can be categorized into four P factors that contribute to poor clinical outcomes: patient characteristics being heterogeneous; physicians underestimating the high ischemic risk compared with bleeding risk; procedure availability; and policy within the healthcare system. To address these challenges, potential approaches include: developing guidelines and protocols that incorporate rigorous definitions of NSTEMI; risk assessment and integrated quality assessment measures; providing education to physicians on the management of long-term cardiovascular risk in patients with NSTEMI; and making stents and antiplatelet therapies more accessible to patients.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Ahrens, Ingo UNSPECIFIED UNSPECIFIED UNSPECIFIED Averkov, Oleg UNSPECIFIED UNSPECIFIED UNSPECIFIED Zuniga, Eduardo C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Fong, Alan Y. Y. UNSPECIFIED UNSPECIFIED UNSPECIFIED Alhabib, Khalid F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Halvorsen, Sigrun UNSPECIFIED UNSPECIFIED UNSPECIFIED Kader, Muhamad A. B. S. K. Abdul UNSPECIFIED UNSPECIFIED UNSPECIFIED Sanz-Ruiz, Ricardo UNSPECIFIED UNSPECIFIED UNSPECIFIED Welsh, Robert UNSPECIFIED UNSPECIFIED UNSPECIFIED Yan, Hongbin UNSPECIFIED UNSPECIFIED UNSPECIFIED Aylward, Philip UNSPECIFIED orcid.org/0000-0002-5358-8552 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-134983
DOI:	10.1002/clc.23232
Journal or Publication Title:	Clin. Cardiol.
Volume:	42
Number:	10
Page Range:	S. 1028 - 1041
Date:	2019
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	1932-8737
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ACUTE CORONARY SYNDROMES; LONG-TERM OUTCOMES; FOCUSED UPDATE; CARDIAC-CATHETERIZATION; PRACTICE GUIDELINES; QUALITY INDICATORS; SYNDROMES INSIGHTS; ARTERY-DISEASE; UNITED-STATES; MANAGEMENT Multiple languages Cardiac & Cardiovascular Systems Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/13498