Characteristics and outcomes of medically managed patients with non-ST-segment elevation acute coronary syndromes: Insights from the multinational EPICOR Asia study

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 from8 countries/ regions in Asia (06/ 2011-05/ 2012). All medicallymanaged NSTE-ACS patientswere 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 2 years. Results: Of 6163 NSTE-ACS patients, 2272 (37%) were medicallymanaged, with 1339 (59%), 254 (11%), and 679 (30%) in the CAG-, CAG+ CAD-, and CAG+ CAD+ groups, respectively. Thereweremarked differences in the proportion of medicallymanaged patients among the 8 countries/ regions (13-81%). Medically managed patients had higher mortality at 2 years compared with revascularization (8.7% vs. 3.0%, p b 0.001). Among medically managed patients, CAG-patients were older, more likely to have pre-existing cardiovascular disease, and had the highest 2-yearmortality (10.5% vs. 4.3% [CAG+ CAD-] and 6.6% [CAG+ CAD+], p b 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. (C) 2017 Elsevier B. V. All rights reserved.