Cohort Analysis Vindicates Invasive Coronary Strategy for NSTEMI (Video)

Few studies are likely to make cardiovascular specialists as proud of their discipline as the large and comprehensive analysis of the Myocardial Ischemia National Audit Project (MINAP) database just presented by UK researchers at this year’s European Society of Cardiology meeting and published online by JAMA.

The analysis is gratifying because it shows that the steady but unglamorous work of incorporating proven therapies into practice in accordance with guidelines really does improve outcomes and save patient lives over time. An accompanying editorial in JAMA calls the study “a success story of ‘bench to bedside’ translation.”

The investigation, a prospective cohort analysis of 389,000 patients with non-ST-elevation myocardial infarction (NSTEMI) in 247 hospitals in England and Wales from 2003 to 2013, found that patients’ clinical risk decreased over the 10-year study period while use of guideline-prescribed care increased.

Most notably, the significant reduction in six-month all-cause mortality — from 10.8 percent in 2003-2004 to 7.6 percent in 2012-2013 — was associated with increased use of an invasive coronary strategy — defined as coronary angiography, PCI or CABG — over time. In fact, about 88 percent of the survival gain was associated with increased use of the invasive coronary strategy and only about 10 percent was attributable to pharmacotherapies.

In this short video, Cleveland Clinic cardiologist Haitham Ahmed, MD, MPH, who was not involved in the study, shares perspectives on the study’s implications for practice and future research.