Conservative management in a contemporary cohort of patients with acute coronary syndrome: results from the FORCE-ACS registry

Abstract Background Contemporary real-world data on conservatively managed patients with acute coronary syndrome (ACS) is scarce. Objective To evaluate conservative management compared revascularization therapy in ACS patients, focused ischemic and bleeding outcomes at one year follow-up, to provide insight physician's rationale of choice for management. Methods From January 2015 2020, were enrolled the FORCE-ACS registry. Patients without identified classified into three groups: 1) No angiography (CAG) performed (CAG−), 2) documented obstructive artery disease (CAD) CAG (CAG+, CAD+) 3) no CAD found CAD−). The first two groups established as those who received revascularization. Survival analyses used assess differences clinical endpoints adjusted potential confounders using cox proportional hazard models. primary endpoint was all-cause mortality, secondary included myocardial infarction (MI), stroke major defined Bleeding Academic Research Consortium (BARC) 3 or 5. Reasons assessed all details antithrombotic (type duration) explored. Results In 5,379 admitted ACS, 93.8% underwent CAG. total, 19.9% did not receive non-revascularized 34.8% during 32.4% 32.7% show Conservatively (14.2%) had lower survival rates revascularized (HR 2.68; 95% CI: 1.89–3.81; p<0.0001). significant MI, stroke, between groups. estimated one-year lowest CAG− group CAG+, CAD+ (adjusted HR 12.24; 4.15–36.07; p<0.001). Most frequent reasons choosing multi-comorbidity, complex anatomy a “watchful waiting” strategy. treated dual triple less often than (84.5% vs 94.6%). Conclusion this contemporary cohort, are higher mortality risk patients. This heterogeneous guideline-recommended therapy. Funding Acknowledgement Type funding sources: Public grant(s) – National budget only. Main source(s): Netherlands Organisation Health, Development (ZonMw)AstraZeneca