Treatment modalities of non-ST-elevation acute coronary syndromes in the real world. Results of the prospective R.OS.A.I.-2 registry

Stefano De Servi, Claudio Cavallini, Antonio Dellavalle, Giovanni Maria Santoro, Erminio Bonizzoni, Antonio Marzocchi, Alesandro Politi, Antonio Pesaresi, Sergio Chierchia, F. Semprini, G. Scaramuzzino, G. Pinelli, L. Pancaldi, C. Antenucci, M. Ongari, G. Fantini, S. Ricci, F. Melandri, A. Maresta, G. PercocoA. Manari, S. Di Stefano, E. Violi, G. Gambarati, A. Rolli, M. Galvani, C. Bruna, B. Doronzo, S. Matta, E. Bellone, M. R. Conte, A. Pesaresi, N. Gandolfo, V. Paolillo, A. De Leo, E. Barbieri, G. Canali, O. Palatini, G. Bilardo, P. Biondi, R. Neri, G. Zuin, M. Ragazzo, P. Maras, M. Cassin, A. Fontebasso, F. Pescoler, R. Bonmassari, W. Oberlechner, A. Fontanelli, M. Libardoni, G. Rigatelli, M. C. Baratello, R. Delfino, F. Della Rovere, A. Camerieri, F. Miccoli, D. Antoniucci, N. Carabba, A. Conti, L. Battelli, A. Fantini, L. Querceto, A. Naldoni, M. Leoncini, F. Bonechi, A. Pesola, L. Robiglio, M. Galli, A. Genovesi, L. Addonisio, M. Taddei, M. Mariani, A. Formentini, G. Lombroso, R. Zanini, A. Izzo, A. Cattabiani, R. Rosiello, G. Canale, L. Simeoni, M. Lettino, R. Villani, R. Osti, M. Orlandi, R. Bonatti, M. Santarone, L. Procopio, S. Repetto, C. Cuccia, E. Bonini, F. Bortolini, P. Rodella

Research output: Contribution to journalArticle

Abstract

Background. Despite advances in the treatment of non-ST-elevation acute coronary syndromes (ACS) based on randomized studies and published guidelines, the extent to which such treatments are applied in daily clinical practice remains elusive. The R.OS.A.I.-2 registry was undertaken to assess the modalities of the treatment of non-ST-elevation ACS, both in terms of the use of drugs, with particular attention to glycoprotein IIb/IIIa inhibitors and clopidogrel, as well as type of strategy, aggressive versus conservative, in a consecutive series of patients admitted to 76 coronary care units (CCU) in Italy. Methods. The R.OS.A.I.-2 study group consisted of 76 hospitals in 7 regions of Northern and Central Italy: 38 centers had a CCU without cath lab facilities (type 1), whereas 38 type 2 centers had a CCU with an on-site interventional cath lab. Globally, 1581 patients with a diagnosis of non-ST-elevation ACS entered the registry during an 8-week period and had a 30-day follow-up. Patients were considered as being aggressively treated if they had coronary arteriography within 96 hours of admission, whereas all other patients were considered as being conservatively treated even if they underwent coronary arteriography after the first 96 hours of hospitalization. Results. An aggressive approach was employed in 789 patients (50%), whereas of the 792 (50%) conservatively treated patients 363 had a late coronary arteriography at a mean of 10.5 ± 13 days after admission. Aggressively treated patients were younger (p <0.0001), had less frequently ST-segment depression (p = 0.04), troponin positivity (p = 0.02), elevated creatine kinase (CK) and/or CK-MB levels within 24 hours of admission (p = 0.01), and had been more often admitted to type 2 hospitals (p <0.0001) than those treated conservatively. Glycoprotein IIb/IIIa blockers (predominantly "small molecules") were more frequently used in younger patients (p = 0.04), in those treated aggressively (p <0.0001), with ST-segment depression (p = 0.01), and in those with a high TIMI risk score (p = 0.001), whereas the use of clopidogrel did not differ in any patient subgroup except in patients <70 years (p = 0.01) and in those treated aggressively (p <0.0001). Percutaneous coronary interventions were performed in 656 patients (481 in the aggressively treated group and 175 in the conservatively treated group). At 30 days, the death rate was 3.4% and the myocardial infarction rate was 5.8%. Age, ST-segment depression, elevated CK and/or CK-MB levels within 24 hours of admission and a conservative approach were significant predictors of an unfavorable outcome. Conclusions. The R.OS.A.I.-2 registry confirms that the population admitted to the CCU with non-ST-elevation ACS has a higher risk profile than that included in recent clinical trials. The aggressive approach is still more dependent on the cath lab availability than on a risk stratification process. Conservatively treated patients have worse clinical features and short-term prognosis. Applying an invasive approach to higher risk groups might further improve the global outcome of non-ST-elevation ACS.

Original languageEnglish
Pages (from-to)782-790
Number of pages9
JournalItalian Heart Journal
Volume4
Issue number11
Publication statusPublished - Nov 2003

Fingerprint

Acute Coronary Syndrome
Registries
Coronary Care Units
clopidogrel
Therapeutics
MB Form Creatine Kinase
Angiography
Platelet Glycoprotein GPIIb-IIIa Complex
Creatine Kinase
Italy
Troponin
Percutaneous Coronary Intervention
Hospitalization
Myocardial Infarction
Clinical Trials
Guidelines

Keywords

  • Acute coronary syndromes
  • Glycoprotein IIb/IIIa inhibitors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

De Servi, S., Cavallini, C., Dellavalle, A., Santoro, G. M., Bonizzoni, E., Marzocchi, A., ... Rodella, P. (2003). Treatment modalities of non-ST-elevation acute coronary syndromes in the real world. Results of the prospective R.OS.A.I.-2 registry. Italian Heart Journal, 4(11), 782-790.

Treatment modalities of non-ST-elevation acute coronary syndromes in the real world. Results of the prospective R.OS.A.I.-2 registry. / De Servi, Stefano; Cavallini, Claudio; Dellavalle, Antonio; Santoro, Giovanni Maria; Bonizzoni, Erminio; Marzocchi, Antonio; Politi, Alesandro; Pesaresi, Antonio; Chierchia, Sergio; Semprini, F.; Scaramuzzino, G.; Pinelli, G.; Pancaldi, L.; Antenucci, C.; Ongari, M.; Fantini, G.; Ricci, S.; Melandri, F.; Maresta, A.; Percoco, G.; Manari, A.; Di Stefano, S.; Violi, E.; Gambarati, G.; Rolli, A.; Galvani, M.; Bruna, C.; Doronzo, B.; Matta, S.; Bellone, E.; Conte, M. R.; Pesaresi, A.; Gandolfo, N.; Paolillo, V.; De Leo, A.; Barbieri, E.; Canali, G.; Palatini, O.; Bilardo, G.; Biondi, P.; Neri, R.; Zuin, G.; Ragazzo, M.; Maras, P.; Cassin, M.; Fontebasso, A.; Pescoler, F.; Bonmassari, R.; Oberlechner, W.; Fontanelli, A.; Libardoni, M.; Rigatelli, G.; Baratello, M. C.; Delfino, R.; Della Rovere, F.; Camerieri, A.; Miccoli, F.; Antoniucci, D.; Carabba, N.; Conti, A.; Battelli, L.; Fantini, A.; Querceto, L.; Naldoni, A.; Leoncini, M.; Bonechi, F.; Pesola, A.; Robiglio, L.; Galli, M.; Genovesi, A.; Addonisio, L.; Taddei, M.; Mariani, M.; Formentini, A.; Lombroso, G.; Zanini, R.; Izzo, A.; Cattabiani, A.; Rosiello, R.; Canale, G.; Simeoni, L.; Lettino, M.; Villani, R.; Osti, R.; Orlandi, M.; Bonatti, R.; Santarone, M.; Procopio, L.; Repetto, S.; Cuccia, C.; Bonini, E.; Bortolini, F.; Rodella, P.

In: Italian Heart Journal, Vol. 4, No. 11, 11.2003, p. 782-790.

Research output: Contribution to journalArticle

De Servi, S, Cavallini, C, Dellavalle, A, Santoro, GM, Bonizzoni, E, Marzocchi, A, Politi, A, Pesaresi, A, Chierchia, S, Semprini, F, Scaramuzzino, G, Pinelli, G, Pancaldi, L, Antenucci, C, Ongari, M, Fantini, G, Ricci, S, Melandri, F, Maresta, A, Percoco, G, Manari, A, Di Stefano, S, Violi, E, Gambarati, G, Rolli, A, Galvani, M, Bruna, C, Doronzo, B, Matta, S, Bellone, E, Conte, MR, Pesaresi, A, Gandolfo, N, Paolillo, V, De Leo, A, Barbieri, E, Canali, G, Palatini, O, Bilardo, G, Biondi, P, Neri, R, Zuin, G, Ragazzo, M, Maras, P, Cassin, M, Fontebasso, A, Pescoler, F, Bonmassari, R, Oberlechner, W, Fontanelli, A, Libardoni, M, Rigatelli, G, Baratello, MC, Delfino, R, Della Rovere, F, Camerieri, A, Miccoli, F, Antoniucci, D, Carabba, N, Conti, A, Battelli, L, Fantini, A, Querceto, L, Naldoni, A, Leoncini, M, Bonechi, F, Pesola, A, Robiglio, L, Galli, M, Genovesi, A, Addonisio, L, Taddei, M, Mariani, M, Formentini, A, Lombroso, G, Zanini, R, Izzo, A, Cattabiani, A, Rosiello, R, Canale, G, Simeoni, L, Lettino, M, Villani, R, Osti, R, Orlandi, M, Bonatti, R, Santarone, M, Procopio, L, Repetto, S, Cuccia, C, Bonini, E, Bortolini, F & Rodella, P 2003, 'Treatment modalities of non-ST-elevation acute coronary syndromes in the real world. Results of the prospective R.OS.A.I.-2 registry', Italian Heart Journal, vol. 4, no. 11, pp. 782-790.
De Servi, Stefano ; Cavallini, Claudio ; Dellavalle, Antonio ; Santoro, Giovanni Maria ; Bonizzoni, Erminio ; Marzocchi, Antonio ; Politi, Alesandro ; Pesaresi, Antonio ; Chierchia, Sergio ; Semprini, F. ; Scaramuzzino, G. ; Pinelli, G. ; Pancaldi, L. ; Antenucci, C. ; Ongari, M. ; Fantini, G. ; Ricci, S. ; Melandri, F. ; Maresta, A. ; Percoco, G. ; Manari, A. ; Di Stefano, S. ; Violi, E. ; Gambarati, G. ; Rolli, A. ; Galvani, M. ; Bruna, C. ; Doronzo, B. ; Matta, S. ; Bellone, E. ; Conte, M. R. ; Pesaresi, A. ; Gandolfo, N. ; Paolillo, V. ; De Leo, A. ; Barbieri, E. ; Canali, G. ; Palatini, O. ; Bilardo, G. ; Biondi, P. ; Neri, R. ; Zuin, G. ; Ragazzo, M. ; Maras, P. ; Cassin, M. ; Fontebasso, A. ; Pescoler, F. ; Bonmassari, R. ; Oberlechner, W. ; Fontanelli, A. ; Libardoni, M. ; Rigatelli, G. ; Baratello, M. C. ; Delfino, R. ; Della Rovere, F. ; Camerieri, A. ; Miccoli, F. ; Antoniucci, D. ; Carabba, N. ; Conti, A. ; Battelli, L. ; Fantini, A. ; Querceto, L. ; Naldoni, A. ; Leoncini, M. ; Bonechi, F. ; Pesola, A. ; Robiglio, L. ; Galli, M. ; Genovesi, A. ; Addonisio, L. ; Taddei, M. ; Mariani, M. ; Formentini, A. ; Lombroso, G. ; Zanini, R. ; Izzo, A. ; Cattabiani, A. ; Rosiello, R. ; Canale, G. ; Simeoni, L. ; Lettino, M. ; Villani, R. ; Osti, R. ; Orlandi, M. ; Bonatti, R. ; Santarone, M. ; Procopio, L. ; Repetto, S. ; Cuccia, C. ; Bonini, E. ; Bortolini, F. ; Rodella, P. / Treatment modalities of non-ST-elevation acute coronary syndromes in the real world. Results of the prospective R.OS.A.I.-2 registry. In: Italian Heart Journal. 2003 ; Vol. 4, No. 11. pp. 782-790.
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title = "Treatment modalities of non-ST-elevation acute coronary syndromes in the real world. Results of the prospective R.OS.A.I.-2 registry",
abstract = "Background. Despite advances in the treatment of non-ST-elevation acute coronary syndromes (ACS) based on randomized studies and published guidelines, the extent to which such treatments are applied in daily clinical practice remains elusive. The R.OS.A.I.-2 registry was undertaken to assess the modalities of the treatment of non-ST-elevation ACS, both in terms of the use of drugs, with particular attention to glycoprotein IIb/IIIa inhibitors and clopidogrel, as well as type of strategy, aggressive versus conservative, in a consecutive series of patients admitted to 76 coronary care units (CCU) in Italy. Methods. The R.OS.A.I.-2 study group consisted of 76 hospitals in 7 regions of Northern and Central Italy: 38 centers had a CCU without cath lab facilities (type 1), whereas 38 type 2 centers had a CCU with an on-site interventional cath lab. Globally, 1581 patients with a diagnosis of non-ST-elevation ACS entered the registry during an 8-week period and had a 30-day follow-up. Patients were considered as being aggressively treated if they had coronary arteriography within 96 hours of admission, whereas all other patients were considered as being conservatively treated even if they underwent coronary arteriography after the first 96 hours of hospitalization. Results. An aggressive approach was employed in 789 patients (50{\%}), whereas of the 792 (50{\%}) conservatively treated patients 363 had a late coronary arteriography at a mean of 10.5 ± 13 days after admission. Aggressively treated patients were younger (p <0.0001), had less frequently ST-segment depression (p = 0.04), troponin positivity (p = 0.02), elevated creatine kinase (CK) and/or CK-MB levels within 24 hours of admission (p = 0.01), and had been more often admitted to type 2 hospitals (p <0.0001) than those treated conservatively. Glycoprotein IIb/IIIa blockers (predominantly {"}small molecules{"}) were more frequently used in younger patients (p = 0.04), in those treated aggressively (p <0.0001), with ST-segment depression (p = 0.01), and in those with a high TIMI risk score (p = 0.001), whereas the use of clopidogrel did not differ in any patient subgroup except in patients <70 years (p = 0.01) and in those treated aggressively (p <0.0001). Percutaneous coronary interventions were performed in 656 patients (481 in the aggressively treated group and 175 in the conservatively treated group). At 30 days, the death rate was 3.4{\%} and the myocardial infarction rate was 5.8{\%}. Age, ST-segment depression, elevated CK and/or CK-MB levels within 24 hours of admission and a conservative approach were significant predictors of an unfavorable outcome. Conclusions. The R.OS.A.I.-2 registry confirms that the population admitted to the CCU with non-ST-elevation ACS has a higher risk profile than that included in recent clinical trials. The aggressive approach is still more dependent on the cath lab availability than on a risk stratification process. Conservatively treated patients have worse clinical features and short-term prognosis. Applying an invasive approach to higher risk groups might further improve the global outcome of non-ST-elevation ACS.",
keywords = "Acute coronary syndromes, Glycoprotein IIb/IIIa inhibitors",
author = "{De Servi}, Stefano and Claudio Cavallini and Antonio Dellavalle and Santoro, {Giovanni Maria} and Erminio Bonizzoni and Antonio Marzocchi and Alesandro Politi and Antonio Pesaresi and Sergio Chierchia and F. Semprini and G. Scaramuzzino and G. Pinelli and L. Pancaldi and C. Antenucci and M. Ongari and G. Fantini and S. Ricci and F. Melandri and A. Maresta and G. Percoco and A. Manari and {Di Stefano}, S. and E. Violi and G. Gambarati and A. Rolli and M. Galvani and C. Bruna and B. Doronzo and S. Matta and E. Bellone and Conte, {M. R.} and A. Pesaresi and N. Gandolfo and V. Paolillo and {De Leo}, A. and E. Barbieri and G. Canali and O. Palatini and G. Bilardo and P. Biondi and R. Neri and G. Zuin and M. Ragazzo and P. Maras and M. Cassin and A. Fontebasso and F. Pescoler and R. Bonmassari and W. Oberlechner and A. Fontanelli and M. Libardoni and G. Rigatelli and Baratello, {M. C.} and R. Delfino and {Della Rovere}, F. and A. Camerieri and F. Miccoli and D. Antoniucci and N. Carabba and A. Conti and L. Battelli and A. Fantini and L. Querceto and A. Naldoni and M. Leoncini and F. Bonechi and A. Pesola and L. Robiglio and M. Galli and A. Genovesi and L. Addonisio and M. Taddei and M. Mariani and A. Formentini and G. Lombroso and R. Zanini and A. Izzo and A. Cattabiani and R. Rosiello and G. Canale and L. Simeoni and M. Lettino and R. Villani and R. Osti and M. Orlandi and R. Bonatti and M. Santarone and L. Procopio and S. Repetto and C. Cuccia and E. Bonini and F. Bortolini and P. Rodella",
year = "2003",
month = "11",
language = "English",
volume = "4",
pages = "782--790",
journal = "Italian Heart Journal",
issn = "1129-471X",
publisher = "Societa Italiana di Cardiologia",
number = "11",

}

TY - JOUR

T1 - Treatment modalities of non-ST-elevation acute coronary syndromes in the real world. Results of the prospective R.OS.A.I.-2 registry

AU - De Servi, Stefano

AU - Cavallini, Claudio

AU - Dellavalle, Antonio

AU - Santoro, Giovanni Maria

AU - Bonizzoni, Erminio

AU - Marzocchi, Antonio

AU - Politi, Alesandro

AU - Pesaresi, Antonio

AU - Chierchia, Sergio

AU - Semprini, F.

AU - Scaramuzzino, G.

AU - Pinelli, G.

AU - Pancaldi, L.

AU - Antenucci, C.

AU - Ongari, M.

AU - Fantini, G.

AU - Ricci, S.

AU - Melandri, F.

AU - Maresta, A.

AU - Percoco, G.

AU - Manari, A.

AU - Di Stefano, S.

AU - Violi, E.

AU - Gambarati, G.

AU - Rolli, A.

AU - Galvani, M.

AU - Bruna, C.

AU - Doronzo, B.

AU - Matta, S.

AU - Bellone, E.

AU - Conte, M. R.

AU - Pesaresi, A.

AU - Gandolfo, N.

AU - Paolillo, V.

AU - De Leo, A.

AU - Barbieri, E.

AU - Canali, G.

AU - Palatini, O.

AU - Bilardo, G.

AU - Biondi, P.

AU - Neri, R.

AU - Zuin, G.

AU - Ragazzo, M.

AU - Maras, P.

AU - Cassin, M.

AU - Fontebasso, A.

AU - Pescoler, F.

AU - Bonmassari, R.

AU - Oberlechner, W.

AU - Fontanelli, A.

AU - Libardoni, M.

AU - Rigatelli, G.

AU - Baratello, M. C.

AU - Delfino, R.

AU - Della Rovere, F.

AU - Camerieri, A.

AU - Miccoli, F.

AU - Antoniucci, D.

AU - Carabba, N.

AU - Conti, A.

AU - Battelli, L.

AU - Fantini, A.

AU - Querceto, L.

AU - Naldoni, A.

AU - Leoncini, M.

AU - Bonechi, F.

AU - Pesola, A.

AU - Robiglio, L.

AU - Galli, M.

AU - Genovesi, A.

AU - Addonisio, L.

AU - Taddei, M.

AU - Mariani, M.

AU - Formentini, A.

AU - Lombroso, G.

AU - Zanini, R.

AU - Izzo, A.

AU - Cattabiani, A.

AU - Rosiello, R.

AU - Canale, G.

AU - Simeoni, L.

AU - Lettino, M.

AU - Villani, R.

AU - Osti, R.

AU - Orlandi, M.

AU - Bonatti, R.

AU - Santarone, M.

AU - Procopio, L.

AU - Repetto, S.

AU - Cuccia, C.

AU - Bonini, E.

AU - Bortolini, F.

AU - Rodella, P.

PY - 2003/11

Y1 - 2003/11

N2 - Background. Despite advances in the treatment of non-ST-elevation acute coronary syndromes (ACS) based on randomized studies and published guidelines, the extent to which such treatments are applied in daily clinical practice remains elusive. The R.OS.A.I.-2 registry was undertaken to assess the modalities of the treatment of non-ST-elevation ACS, both in terms of the use of drugs, with particular attention to glycoprotein IIb/IIIa inhibitors and clopidogrel, as well as type of strategy, aggressive versus conservative, in a consecutive series of patients admitted to 76 coronary care units (CCU) in Italy. Methods. The R.OS.A.I.-2 study group consisted of 76 hospitals in 7 regions of Northern and Central Italy: 38 centers had a CCU without cath lab facilities (type 1), whereas 38 type 2 centers had a CCU with an on-site interventional cath lab. Globally, 1581 patients with a diagnosis of non-ST-elevation ACS entered the registry during an 8-week period and had a 30-day follow-up. Patients were considered as being aggressively treated if they had coronary arteriography within 96 hours of admission, whereas all other patients were considered as being conservatively treated even if they underwent coronary arteriography after the first 96 hours of hospitalization. Results. An aggressive approach was employed in 789 patients (50%), whereas of the 792 (50%) conservatively treated patients 363 had a late coronary arteriography at a mean of 10.5 ± 13 days after admission. Aggressively treated patients were younger (p <0.0001), had less frequently ST-segment depression (p = 0.04), troponin positivity (p = 0.02), elevated creatine kinase (CK) and/or CK-MB levels within 24 hours of admission (p = 0.01), and had been more often admitted to type 2 hospitals (p <0.0001) than those treated conservatively. Glycoprotein IIb/IIIa blockers (predominantly "small molecules") were more frequently used in younger patients (p = 0.04), in those treated aggressively (p <0.0001), with ST-segment depression (p = 0.01), and in those with a high TIMI risk score (p = 0.001), whereas the use of clopidogrel did not differ in any patient subgroup except in patients <70 years (p = 0.01) and in those treated aggressively (p <0.0001). Percutaneous coronary interventions were performed in 656 patients (481 in the aggressively treated group and 175 in the conservatively treated group). At 30 days, the death rate was 3.4% and the myocardial infarction rate was 5.8%. Age, ST-segment depression, elevated CK and/or CK-MB levels within 24 hours of admission and a conservative approach were significant predictors of an unfavorable outcome. Conclusions. The R.OS.A.I.-2 registry confirms that the population admitted to the CCU with non-ST-elevation ACS has a higher risk profile than that included in recent clinical trials. The aggressive approach is still more dependent on the cath lab availability than on a risk stratification process. Conservatively treated patients have worse clinical features and short-term prognosis. Applying an invasive approach to higher risk groups might further improve the global outcome of non-ST-elevation ACS.

AB - Background. Despite advances in the treatment of non-ST-elevation acute coronary syndromes (ACS) based on randomized studies and published guidelines, the extent to which such treatments are applied in daily clinical practice remains elusive. The R.OS.A.I.-2 registry was undertaken to assess the modalities of the treatment of non-ST-elevation ACS, both in terms of the use of drugs, with particular attention to glycoprotein IIb/IIIa inhibitors and clopidogrel, as well as type of strategy, aggressive versus conservative, in a consecutive series of patients admitted to 76 coronary care units (CCU) in Italy. Methods. The R.OS.A.I.-2 study group consisted of 76 hospitals in 7 regions of Northern and Central Italy: 38 centers had a CCU without cath lab facilities (type 1), whereas 38 type 2 centers had a CCU with an on-site interventional cath lab. Globally, 1581 patients with a diagnosis of non-ST-elevation ACS entered the registry during an 8-week period and had a 30-day follow-up. Patients were considered as being aggressively treated if they had coronary arteriography within 96 hours of admission, whereas all other patients were considered as being conservatively treated even if they underwent coronary arteriography after the first 96 hours of hospitalization. Results. An aggressive approach was employed in 789 patients (50%), whereas of the 792 (50%) conservatively treated patients 363 had a late coronary arteriography at a mean of 10.5 ± 13 days after admission. Aggressively treated patients were younger (p <0.0001), had less frequently ST-segment depression (p = 0.04), troponin positivity (p = 0.02), elevated creatine kinase (CK) and/or CK-MB levels within 24 hours of admission (p = 0.01), and had been more often admitted to type 2 hospitals (p <0.0001) than those treated conservatively. Glycoprotein IIb/IIIa blockers (predominantly "small molecules") were more frequently used in younger patients (p = 0.04), in those treated aggressively (p <0.0001), with ST-segment depression (p = 0.01), and in those with a high TIMI risk score (p = 0.001), whereas the use of clopidogrel did not differ in any patient subgroup except in patients <70 years (p = 0.01) and in those treated aggressively (p <0.0001). Percutaneous coronary interventions were performed in 656 patients (481 in the aggressively treated group and 175 in the conservatively treated group). At 30 days, the death rate was 3.4% and the myocardial infarction rate was 5.8%. Age, ST-segment depression, elevated CK and/or CK-MB levels within 24 hours of admission and a conservative approach were significant predictors of an unfavorable outcome. Conclusions. The R.OS.A.I.-2 registry confirms that the population admitted to the CCU with non-ST-elevation ACS has a higher risk profile than that included in recent clinical trials. The aggressive approach is still more dependent on the cath lab availability than on a risk stratification process. Conservatively treated patients have worse clinical features and short-term prognosis. Applying an invasive approach to higher risk groups might further improve the global outcome of non-ST-elevation ACS.

KW - Acute coronary syndromes

KW - Glycoprotein IIb/IIIa inhibitors

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UR - http://www.scopus.com/inward/citedby.url?scp=2142686086&partnerID=8YFLogxK

M3 - Article

C2 - 14699708

AN - SCOPUS:2142686086

VL - 4

SP - 782

EP - 790

JO - Italian Heart Journal

JF - Italian Heart Journal

SN - 1129-471X

IS - 11

ER -