Early invasive versus ischaemia-guided strategies in the management of non-Q wave myocardial infarction patients with and without prior myocardial infarction. Results of Veterans Affairs Non-Q Wave Infarction Strategies In Hospital (VANQWISH) trial
Aims To compare the role of early invasive vs conservative management strategies in treating patients with non-Q wave myocardial infarction with or without a prior myocardial infarction. Background In patients recovering from non-Q wave myocardial infarction, the prognosis among patients with a firs...
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| Veröffentlicht in: | European heart journal 2000-12, Vol.21 (24), p.2014-2025 |
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| container_title | European heart journal |
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| creator | Heggunje, P.S Wade, M.J O'Rourke, R.A Kleiger, R.E Deedwania, P.C Lavori, P.W Boden, W.E |
| description | Aims To compare the role of early invasive vs conservative management strategies in treating patients with non-Q wave myocardial infarction with or without a prior myocardial infarction. Background In patients recovering from non-Q wave myocardial infarction, the prognosis among patients with a first non-Q wave myocardial infarction is significantly better than in patients with a prior myocardial infarction, yet physicians often adopt an early invasive strategy to treat patients with a first non-Q wave myocardial infarction. Methods Non-Q wave myocardial infarction patients enrolled in the VANQWISH trial with a history of prior myocardial infarction were compared to those with a first non-Q wave myocardial infarction, for the trial primary end-point of death or myocardial infarction at 1 and 12 months, as well as for the initial randomized treatment strategy. Results Of the 920 non-Q wave myocardial infarction patients, 396 had a history of prior myocardial infarction and 524 did not. Patients with a history of prior myocardial infarction were older and had a higher incidence of multiple high-risk baseline characteristics than those with a first non-Q wave myocardial infarction. Compared to the group with a first myocardial infarction, the prior myocardial infarction group suffered more events at both 1 month (11% vs 6%, P=0·007) and at 12 months (29% vs 16%, P |
| doi_str_mv | 10.1053/euhj.2000.2423 |
| format | Article |
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Results of Veterans Affairs Non-Q Wave Infarction Strategies In Hospital (VANQWISH) trial</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Oxford University Press Journals All Titles (1996-Current)</source><creator>Heggunje, P.S ; Wade, M.J ; O'Rourke, R.A ; Kleiger, R.E ; Deedwania, P.C ; Lavori, P.W ; Boden, W.E</creator><creatorcontrib>Heggunje, P.S ; Wade, M.J ; O'Rourke, R.A ; Kleiger, R.E ; Deedwania, P.C ; Lavori, P.W ; Boden, W.E ; VANQWISH trial investigators</creatorcontrib><description>Aims To compare the role of early invasive vs conservative management strategies in treating patients with non-Q wave myocardial infarction with or without a prior myocardial infarction. Background In patients recovering from non-Q wave myocardial infarction, the prognosis among patients with a first non-Q wave myocardial infarction is significantly better than in patients with a prior myocardial infarction, yet physicians often adopt an early invasive strategy to treat patients with a first non-Q wave myocardial infarction. Methods Non-Q wave myocardial infarction patients enrolled in the VANQWISH trial with a history of prior myocardial infarction were compared to those with a first non-Q wave myocardial infarction, for the trial primary end-point of death or myocardial infarction at 1 and 12 months, as well as for the initial randomized treatment strategy. Results Of the 920 non-Q wave myocardial infarction patients, 396 had a history of prior myocardial infarction and 524 did not. Patients with a history of prior myocardial infarction were older and had a higher incidence of multiple high-risk baseline characteristics than those with a first non-Q wave myocardial infarction. Compared to the group with a first myocardial infarction, the prior myocardial infarction group suffered more events at both 1 month (11% vs 6%, P=0·007) and at 12 months (29% vs 16%, P<0·001). This difference in outcome remained significant even after adjusting for confounding variables (P<0·0001 at 12 months). Among the non-Q wave myocardial infarction patients with a prior myocardial infarction, the frequency of death or recurrent myocardial infarction was similar in both invasive and conservative groups during the first year of follow-up. Among the first non-Q wave myocardial infarction group, those assigned to the conservative strategy had significantly fewer events (3% vs 9%,P =0·009 at 1 month; 12% vs 20%, P=0·016 at 12 months) and mortality (1% vs 5%, P=0·012 at one month; 5% vs 11%, P=0·009 at 12 months) than those assigned to early invasive strategy. Conclusion A history of prior myocardial infarction identifies a moderately high-risk subset of non-Q wave myocardial infarction patients who display similar long-term outcomes regardless of the strategy assignment; however, patients with a first non-Q wave myocardial infarction may fare better with a conservative or ischaemia-guided approach during the first post infarction year.</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1053/euhj.2000.2423</identifier><identifier>PMID: 11102252</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Aged ; Biological and medical sciences ; Cardiology. Vascular system ; Coronary heart disease ; Female ; Heart ; Humans ; invasive ; ischaemia-guided ; Male ; Medical sciences ; Middle Aged ; Myocardial Infarction - physiopathology ; Myocardial Infarction - therapy ; Myocardial Revascularization - methods ; Non-Q wave myocardial infarction ; Proportional Hazards Models ; Recurrence ; Risk ; Survival Analysis</subject><ispartof>European heart journal, 2000-12, Vol.21 (24), p.2014-2025</ispartof><rights>2001 INIST-CNRS</rights><rights>Copyright 2000 The European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c397t-d187b2188e7874d932dd774fb4d4e7ca9275d9b2d6cae2d7933870102963993f3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=825752$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11102252$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Heggunje, P.S</creatorcontrib><creatorcontrib>Wade, M.J</creatorcontrib><creatorcontrib>O'Rourke, R.A</creatorcontrib><creatorcontrib>Kleiger, R.E</creatorcontrib><creatorcontrib>Deedwania, P.C</creatorcontrib><creatorcontrib>Lavori, P.W</creatorcontrib><creatorcontrib>Boden, W.E</creatorcontrib><creatorcontrib>VANQWISH trial investigators</creatorcontrib><title>Early invasive versus ischaemia-guided strategies in the management of non-Q wave myocardial infarction patients with and without prior myocardial infarction. Results of Veterans Affairs Non-Q Wave Infarction Strategies In Hospital (VANQWISH) trial</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description>Aims To compare the role of early invasive vs conservative management strategies in treating patients with non-Q wave myocardial infarction with or without a prior myocardial infarction. Background In patients recovering from non-Q wave myocardial infarction, the prognosis among patients with a first non-Q wave myocardial infarction is significantly better than in patients with a prior myocardial infarction, yet physicians often adopt an early invasive strategy to treat patients with a first non-Q wave myocardial infarction. Methods Non-Q wave myocardial infarction patients enrolled in the VANQWISH trial with a history of prior myocardial infarction were compared to those with a first non-Q wave myocardial infarction, for the trial primary end-point of death or myocardial infarction at 1 and 12 months, as well as for the initial randomized treatment strategy. Results Of the 920 non-Q wave myocardial infarction patients, 396 had a history of prior myocardial infarction and 524 did not. Patients with a history of prior myocardial infarction were older and had a higher incidence of multiple high-risk baseline characteristics than those with a first non-Q wave myocardial infarction. Compared to the group with a first myocardial infarction, the prior myocardial infarction group suffered more events at both 1 month (11% vs 6%, P=0·007) and at 12 months (29% vs 16%, P<0·001). This difference in outcome remained significant even after adjusting for confounding variables (P<0·0001 at 12 months). Among the non-Q wave myocardial infarction patients with a prior myocardial infarction, the frequency of death or recurrent myocardial infarction was similar in both invasive and conservative groups during the first year of follow-up. Among the first non-Q wave myocardial infarction group, those assigned to the conservative strategy had significantly fewer events (3% vs 9%,P =0·009 at 1 month; 12% vs 20%, P=0·016 at 12 months) and mortality (1% vs 5%, P=0·012 at one month; 5% vs 11%, P=0·009 at 12 months) than those assigned to early invasive strategy. Conclusion A history of prior myocardial infarction identifies a moderately high-risk subset of non-Q wave myocardial infarction patients who display similar long-term outcomes regardless of the strategy assignment; however, patients with a first non-Q wave myocardial infarction may fare better with a conservative or ischaemia-guided approach during the first post infarction year.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Coronary heart disease</subject><subject>Female</subject><subject>Heart</subject><subject>Humans</subject><subject>invasive</subject><subject>ischaemia-guided</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Myocardial Infarction - therapy</subject><subject>Myocardial Revascularization - methods</subject><subject>Non-Q wave myocardial infarction</subject><subject>Proportional Hazards Models</subject><subject>Recurrence</subject><subject>Risk</subject><subject>Survival Analysis</subject><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptkc9v0zAUxyMEYqVw5YgsIU1wSIntJE6O1bTRStNQ2VgnLtZr_NJ6JE6xnY7-5xxxf2i9cLKl93nf79P3G0XvaTKiSca_YL96HLEkSUYsZfxFNKAZY3GZp9nLaJDQMovzvHg4i9449xioIqf56-iMUpowlrFB9PcSbLMl2mzA6Q2SDVrXO6JdtQJsNcTLXitUxHkLHpcaw8wQv0LSgoEltmg86WpiOhPPyBMEiXbbVWCVhiagNdjK686QNXgdWEeetF8RMGr_6XpP1lZ39v9bI_IdXd-ErWBxjx4tGEfGdQ3aOnKz95zvPKcno9vTpVNDJp1bax9EP92Pb2bz6e3kM_E2uLyNXtXQOHx3fIfRj6vLu4tJfP3t6_RifB1XvBQ-VrQQC0aLAkUhUlVyppQQab1IVYqigpKJTJULpvIKkClRcl6IJKRb5rwsec2H0flBd2273z06L9sQLjYNGOx6J0XoTaQBHUajA1jZzjmLtQzBtGC3kiZy17XcdS13Xctd12Hhw1G5X7SoTvix3AB8PALgKmjqEF6l3TNXsEzsqfhAaefxz_MU7C-ZCy4yOXn4Kefsis1mZS7v-D94-8aF</recordid><startdate>20001201</startdate><enddate>20001201</enddate><creator>Heggunje, P.S</creator><creator>Wade, M.J</creator><creator>O'Rourke, R.A</creator><creator>Kleiger, R.E</creator><creator>Deedwania, P.C</creator><creator>Lavori, P.W</creator><creator>Boden, W.E</creator><general>Oxford University Press</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20001201</creationdate><title>Early invasive versus ischaemia-guided strategies in the management of non-Q wave myocardial infarction patients with and without prior myocardial infarction. Results of Veterans Affairs Non-Q Wave Infarction Strategies In Hospital (VANQWISH) trial</title><author>Heggunje, P.S ; Wade, M.J ; O'Rourke, R.A ; Kleiger, R.E ; Deedwania, P.C ; Lavori, P.W ; Boden, W.E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c397t-d187b2188e7874d932dd774fb4d4e7ca9275d9b2d6cae2d7933870102963993f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Coronary heart disease</topic><topic>Female</topic><topic>Heart</topic><topic>Humans</topic><topic>invasive</topic><topic>ischaemia-guided</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Myocardial Infarction - therapy</topic><topic>Myocardial Revascularization - methods</topic><topic>Non-Q wave myocardial infarction</topic><topic>Proportional Hazards Models</topic><topic>Recurrence</topic><topic>Risk</topic><topic>Survival Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Heggunje, P.S</creatorcontrib><creatorcontrib>Wade, M.J</creatorcontrib><creatorcontrib>O'Rourke, R.A</creatorcontrib><creatorcontrib>Kleiger, R.E</creatorcontrib><creatorcontrib>Deedwania, P.C</creatorcontrib><creatorcontrib>Lavori, P.W</creatorcontrib><creatorcontrib>Boden, W.E</creatorcontrib><creatorcontrib>VANQWISH trial investigators</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Heggunje, P.S</au><au>Wade, M.J</au><au>O'Rourke, R.A</au><au>Kleiger, R.E</au><au>Deedwania, P.C</au><au>Lavori, P.W</au><au>Boden, W.E</au><aucorp>VANQWISH trial investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early invasive versus ischaemia-guided strategies in the management of non-Q wave myocardial infarction patients with and without prior myocardial infarction. Results of Veterans Affairs Non-Q Wave Infarction Strategies In Hospital (VANQWISH) trial</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2000-12-01</date><risdate>2000</risdate><volume>21</volume><issue>24</issue><spage>2014</spage><epage>2025</epage><pages>2014-2025</pages><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Aims To compare the role of early invasive vs conservative management strategies in treating patients with non-Q wave myocardial infarction with or without a prior myocardial infarction. Background In patients recovering from non-Q wave myocardial infarction, the prognosis among patients with a first non-Q wave myocardial infarction is significantly better than in patients with a prior myocardial infarction, yet physicians often adopt an early invasive strategy to treat patients with a first non-Q wave myocardial infarction. Methods Non-Q wave myocardial infarction patients enrolled in the VANQWISH trial with a history of prior myocardial infarction were compared to those with a first non-Q wave myocardial infarction, for the trial primary end-point of death or myocardial infarction at 1 and 12 months, as well as for the initial randomized treatment strategy. Results Of the 920 non-Q wave myocardial infarction patients, 396 had a history of prior myocardial infarction and 524 did not. Patients with a history of prior myocardial infarction were older and had a higher incidence of multiple high-risk baseline characteristics than those with a first non-Q wave myocardial infarction. Compared to the group with a first myocardial infarction, the prior myocardial infarction group suffered more events at both 1 month (11% vs 6%, P=0·007) and at 12 months (29% vs 16%, P<0·001). This difference in outcome remained significant even after adjusting for confounding variables (P<0·0001 at 12 months). Among the non-Q wave myocardial infarction patients with a prior myocardial infarction, the frequency of death or recurrent myocardial infarction was similar in both invasive and conservative groups during the first year of follow-up. Among the first non-Q wave myocardial infarction group, those assigned to the conservative strategy had significantly fewer events (3% vs 9%,P =0·009 at 1 month; 12% vs 20%, P=0·016 at 12 months) and mortality (1% vs 5%, P=0·012 at one month; 5% vs 11%, P=0·009 at 12 months) than those assigned to early invasive strategy. Conclusion A history of prior myocardial infarction identifies a moderately high-risk subset of non-Q wave myocardial infarction patients who display similar long-term outcomes regardless of the strategy assignment; however, patients with a first non-Q wave myocardial infarction may fare better with a conservative or ischaemia-guided approach during the first post infarction year.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>11102252</pmid><doi>10.1053/euhj.2000.2423</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Biological and medical sciences Cardiology. Vascular system Coronary heart disease Female Heart Humans invasive ischaemia-guided Male Medical sciences Middle Aged Myocardial Infarction - physiopathology Myocardial Infarction - therapy Myocardial Revascularization - methods Non-Q wave myocardial infarction Proportional Hazards Models Recurrence Risk Survival Analysis |
| title | Early invasive versus ischaemia-guided strategies in the management of non-Q wave myocardial infarction patients with and without prior myocardial infarction. Results of Veterans Affairs Non-Q Wave Infarction Strategies In Hospital (VANQWISH) trial |
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