Outcomes with invasive vs conservative management of @entity1455 complicating XXXX .

@entity1 @entity583 @entity1455
BACKGROUND: In the SHOCK trial, an invasive strategy of early revascularization was associated with a significant mortality benefit at 6 months when compared with initial stabilization in @entity1 with @entity1455 complicating @entity583 . Our objectives were to evaluate the data on real-world practice and outcomes of invasive vs conservative management in @entity1 with @entity1455 . METHODS: We analyzed data from the Nationwide Inpatient Sample from 2002 to 2011 with primary discharge diagnosis of @entity583 and secondary diagnosis of @entity1455 . Propensity score matching was used to assemble a cohort of @entity1 managed invasively (with cardiac catheterization, percutaneous coronary intervention, or coronary artery bypass graft surgery) vs conservatively with similar baseline characteristics. The primary outcome was in-hospital mortality. RESULTS: We identified 60,833 @entity1 with @entity1455 , of which 20,644 @entity1 (10,322 in each group) with similar propensity scores, including 11,004 elderly @entity1 (>= 75 years), were in the final analysis. @entity1 who underwent invasive management had 59% lower odds of in-hospital mortality (37.7% vs 59.7%; odds ratio [OR] 0.41; 95% confidence interval [CI], 0.39-0.43; P < .0001) when compared with those managed conservatively. This lower mortality was consistently seen across all tested subgroups; specifically in the elderly (>= 75 years) (44.0% vs 63.6%; OR 0.45; 95% CI, 0.42-0.49; P  <  .0001) and those younger than 75 years (30.6% vs 55.1%; OR 0.36; 95% CI, 0.33-0.39; P < .0001), although the magnitude of risk reduction differed (Pinteraction < .0001). CONCLUSIONS: In this largest cohort of @entity1 with @entity1455 complicating @entity583 , @entity1 managed invasively had significantly lower mortality when compared with those managed conservatively, even in the elderly. Our results emphasize the need for aggressive management in this high-risk subgroup.
