Impact of early (<24h) versus delayed (>24h) intervention in patients with non ST segment elevation myocardial infarction (an observational study of 20882 patients). (25th November 2020)

• Record Type: Journal Article
• Authors: Panoulas, V; Rathod, K; Kain, A; Firoozi, S; Nevett, J; Kalra, S; Malik, I; Mathur, A; Redwood, S; MacCarthy, P.A; Wragg, A; Jones, D; Dalby, M.C
• Is Part Of: European heart journal. Volume 41:(2020)Supplement 2
• Publication Date: 2020-11-25
• Subjects: Coronary Intervention: Outcome; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/ehjci/ehaa946.2523
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: In patients presenting with non ST-segment elevation acute coronary syndromes (NSTE-ACS) an invasive approach has been shown to be superior to conservative management. Purpose: We aimed to investigate the optimal timing of invasive coronary angiography and subsequent intervention. Methods: We examined the impact ofearly (≤24h) versus delayed (&gt;24h) intervention in a large observational cohort of 20882 consecutive patients with acute NSTE myocardial infarction (NSTEMI) treated with PCI between 2005 and 2015 at 9 tertiary cardiac centers in London (UK) using Cox-regression analysis and propensity matching. Results: Mean age was 64.5±12.7 years and 26.1% were females. A quarter (27.6%), were treated within 24h.Patients treated within 24h were slightly younger (62.8±12.8 vs. 65.2±12.6, p&lt;0.001), most commonly male (76% vs. 72.9%, p&lt;0.001) and were more frequently ventilated (2.3% vs. 1.4%, p&lt;0.001) and in cardiogenic shock (3.6% vs. 1.4%, p&lt;0.001) with dynamic changes on their ECG (84.5% vs. 76.1% p&lt;0.001). At a median follow up of 4.2 years (interquartile range 1.8 to 7) 17.7% of patients had died. Estimated 5-year survival in patients treated within 24h was 84.6% vs. 81% for those treated &gt;24h following their presentation (p&lt;0.001). This survival benefit remained following adjustment for confounders; HR (delayed vs. early management)1.11 (95% CI 1.003 to 1.23, p=0.046). In the propensity matched cohort of 4356 patients in each group, there remained a trend for higher survival in the early intervention group (p=0.061). Conclusions: Notwithstanding the limitations of the retrospective design, this real-world cohort of NSTEMI patients suggests that an early intervention (≤24h) may improve mid term survival. Funding Acknowledgement: Type of funding source: None