Original Title: Spontaneous MI after Non–ST-Segment Elevation Acute Coronary Syndrome Managed without Revascularization. The TRILOGY ACS Trial. Reference: Renato D. Lopes et al. J Am Coll Cardiol. 2016;67(11):1289-1297.
Patients admitted with acute coronary syndromes (ACS) and especially those managed conservatively without revascularization, are at high risk of a new spontaneous infarction. However, MI risk rate and predictors are unknown.
This study seeks to characterize spontaneous MI rate at 30 days in the TRILOGY ACS population admitted with non ST elevation ACS (TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medically manage Acute Coronary Syndromes) that randomized patients to aspirin and clopidogrel vs. aspirin and prasugrel.
The study included 9294 patients with NSTEMI and unstable angina medically managed without revascularization.
A Cox risk model was used to determine MI predictors at 30 months and after model validation, researchers developed a calculator for model implementation.
Among the 9294 patients managed without revascularization strategy, there were 695 spontaneous infarctions over a median 17 months representing 94% of infarctions adjudicated in the study.
The strongest MI risk predictors were older age, NSTEMI vs. unstable angina as index event, diabetes, absence of angiography prior randomization and elevated creatinine values. The model had good discriminating capabilities and good calibration (c-index = 0.732), especially for patients with low and moderate risk of spontaneous MI.
Conclusion
Spontaneous ACS after medical management is frequent. Baseline statistics can be used to predict risk in this population. These findings provide information on the long term natural evolution of patients medically managed without revascularization.
