Disparities in Management Patterns and Outcomes of Patients With Non–ST-Elevation Acute Coronary Syndrome With and Without a History of Cerebrovascular Disease

• Published in: The American journal of cardiology 2010-04, Vol.105 (8), p.1083-1089
• Main Authors: Lee, Tony C., MD, MSc, Goodman, Shaun G., MD, MSc, Yan, Raymond T., MD, Grondin, Francois R., MD, Welsh, Robert C., MD, Rose, Barry, MD, Gyenes, Gabor, MD, Zimmerman, Rodney H., MD, Brossoit, Real, MD, Saposnik, Gustavo, MD, Graham, John J., MD, Yan, Andrew T., MD
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - epidemiology; Acute Coronary Syndrome - therapy; Acute coronary syndromes; Aged; Aged, 80 and over; Biological and medical sciences; Canada - epidemiology; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Cerebrovascular Disorders - complications; Cerebrovascular Disorders - epidemiology; Clinical outcomes; Coronary Angiography; Coronary heart disease; Coronary vessels; Diagnosis, Differential; Early Diagnosis; Electrocardiography; Female; Follow-Up Studies; Healthcare Disparities - statistics & numerical data; Heart; Humans; Male; Medical imaging; Medical research; Medical sciences; Middle Aged; Morbidity - trends; Myocardial Revascularization; Myocarditis. Cardiomyopathies; Neurology; Prospective Studies; Registries; Risk Factors; Survival Rate - trends; Thrombolytic drugs; Thrombolytic Therapy; Time Factors; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2009.12.005

Cerebrovascular (CVD) disease is commonly associated with coronary artery disease and adversely affects outcome. The goal of the present study was to examine the temporal management patterns and outcomes in relation to previous CVD in a contemporary “real-world” spectrum of patients with acute coronary syndrome (ACS). From 1999 to 2008, 14,070 patients with non–ST-segment elevation ACS were recruited into the Canadian Acute Coronary Syndrome I (ACS I), ACS II, Global Registry of Acute Coronary Events (GRACE/GRACE2 ), and Canadian Registry of Acute Coronary Events (CANRACE) prospective multicenter registries. We stratified the study patients according to a history of CVD and compared their treatment and outcomes. Patients with a history of CVD were older, more likely to have pre-existing coronary artery disease, elevated creatinine, higher Killip class, and ST-segment deviation on admission. Despite presenting with greater GRACE risk scores (137 vs 117, p