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Use of risk stratification to identify patients with unstable angina likeliest to benefit from an invasive versus conservative management strategy

Daniel H. Solomon, MD, MPH^*, Peter H. Stone, MD, FACC, Robert J. Glynn, PhD, ScD^*, David A. Ganz, MD, MPH^*, C. Michael Gibson, MD, MSc, FACC, Russell Tracy, PhD and Jerry Avorn, MD^*

^* Division of Pharmacoepidemiology and Pharmacoeconomics, Boston, Massachusetts, USA
Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Division of Cardiology, University of California–San Francisco, San Francisco, California, USA
Department of Pathology, University of Vermont College of Medicine, Colchester, Vermont, USA

View larger version (30K): [in a new window]   Figure 1 (A) Rates of death or myocardial infarction (MI) by 42 days. (B) Rates of death or MI by 365 days. Patients treated with conservative (medical) management (black bars) had a significantly higher rate of death or MI by 42 days in increasing risk categories (92% adjusted increase per category, 95% confidence interval, [CI] 67% to 116%) compared with patients treated with the early invasive strategy (white bars) (only 31% adjusted increase per category, 95% CI, 4% to 67%; p = 0.03). Although the trend was similar for death or myocardial infarction by 365 days, the interaction between risk category and management assignment did not reach statistical significance (p = 0.3).