In-Hospital Outcomes According to Treatment Strategy in NSTEMI Patients Undergoing Coronary Angiography: No Index Revascularization, PCI, or CABG?
4 affiliations
- 1Department of Cardiovascular Surgery, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara 06800, Türkiye
- 2Department of Cardiovascular Surgery, Ankara Bilkent City Hospital, Ankara 06800, Türkiye
- 3Department of Cardiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara 06800, Türkiye
- 4Department of Cardiology, Ankara Bilkent City Hospital, Ankara 06800, Türkiye
Abstract
Background/Objectives: Real-world data comparing treatment strategies and in-hospital outcomes across no index revascularization, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) in NSTEMI patients remain limited. Methods: In this single-center retrospective cohort study, 1906 NSTEMI patients undergoing coronary angiography were categorized into no index revascularization (n = 946), PCI (n = 709), or CABG (n = 251) groups. The primary endpoint was in-hospital major adverse cardiovascular events (MACE), defined as all-cause mortality, cardiac arrest requiring cardiopulmonary resuscitation, sustained ventricular tachycardia/ventricular fibrillation, dialysis-requiring acute kidney injury, or stroke. Missing data were handled using multiple imputation with chained equations (MICE), and propensity score-based inverse probability of treatment weighting (IPTW) was used as a sensitivity analysis. Results: In-hospital MACE was higher in the no index revascularization group than in the PCI and CABG groups (9.8% vs. 3.5% vs. 4.8%; p < 0.001). Patients managed with no index revascularization were older and had a greater comorbidity burden, lower left ventricular ejection fraction, and more frequent Killip class ≥ 2. In the primary multivariable model, chronic kidney disease, Killip class ≥ 2, lower LVEF, CRP, and male sex were associated with in-hospital MACE, whereas neither PCI nor CABG strategy was independently associated with MACE. IPTW sensitivity analyses yielded similar directions of association; however, the PCI estimate crossed the conventional significance threshold after 1st–99th percentile weight truncation. Conclusions: Patients managed with no index revascularization had a higher baseline risk profile and higher unadjusted in-hospital MACE and mortality. The observed between-group differences should be interpreted as associations rather than causal effects of treatment strategy because of substantial confounding by indication.
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BibTeX
@article{erdogan2026inhospital,
title = {{In-Hospital Outcomes According to Treatment Strategy in NSTEMI Patients Undergoing Coronary Angiography: No Index Revascularization, PCI, or CABG?}},
author = {Kemal Eşref Erdoğan and Muhammet Fethi Sağlam and Serdal Baştuğ and Burak Kardeşler and Emrah Uğuz and Etga Köprücü and Murat Yücel and Mehmet Murat Yiğitbaşı and Kamuran Kalkan and Hüseyin Bayram and Murat Akçay},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207872},
url = {https://www.mdpi.com/2077-0383/15/20/7872},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - In-Hospital Outcomes According to Treatment Strategy in NSTEMI Patients Undergoing Coronary Angiography: No Index Revascularization, PCI, or CABG?
AU - Kemal Eşref Erdoğan
AU - Muhammet Fethi Sağlam
AU - Serdal Baştuğ
AU - Burak Kardeşler
AU - Emrah Uğuz
AU - Etga Köprücü
AU - Murat Yücel
AU - Mehmet Murat Yiğitbaşı
AU - Kamuran Kalkan
AU - Hüseyin Bayram
AU - Murat Akçay
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207872
UR - https://www.mdpi.com/2077-0383/15/20/7872
AB - Background/Objectives: Real-world data comparing treatment strategies and in-hospital outcomes across no index revascularization, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) in NSTEMI patients remain limited. Methods: In this single-center retrospective cohort study, 1906 NSTEMI patients undergoing coronary angiography were categorized into no index revascularization (n = 946), PCI (n = 709), or CABG (n = 251) groups. The primary endpoint was in-hospital major adverse cardiovascular events (MACE), defined as all-cause mortality, cardiac arrest requiring cardiopulmonary resuscitation, sustained ventricular tachycardia/ventricular fibrillation, dialysis-requiring acute kidney injury, or stroke. Missing data were handled using multiple imputation with chained equations (MICE), and propensity score-based inverse probability of treatment weighting (IPTW) was used as a sensitivity analysis. Results: In-hospital MACE was higher in the no index revascularization group than in the PCI and CABG groups (9.8% vs. 3.5% vs. 4.8%; p < 0.001). Patients managed with no index revascularization were older and had a greater comorbidity burden, lower left ventricular ejection fraction, and more frequent Killip class ≥ 2. In the primary multivariable model, chronic kidney disease, Killip class ≥ 2, lower LVEF, CRP, and male sex were associated with in-hospital MACE, whereas neither PCI nor CABG strategy was independently associated with MACE. IPTW sensitivity analyses yielded similar directions of association; however, the PCI estimate crossed the conventional significance threshold after 1st–99th percentile weight truncation. Conclusions: Patients managed with no index revascularization had a higher baseline risk profile and higher unadjusted in-hospital MACE and mortality. The observed between-group differences should be interpreted as associations rather than causal effects of treatment strategy because of substantial confounding by indication.
SN - 2077-0383
ER -