Takeaway
- This real-world cohort of non-ST-segment elevation acute myocardial infarction (NSTEMI) patients suggests that an early coronary angiography and intervention (≤24 hours) may improve mid-term survival.
Why this matters
- If findings are validated in large randomized trials, there is scope for changing current practices to a more timely and prompt intervention in those admitted with NSTEMI.
Study design
- A retrospective analysis of 20,978 patients with NSTEMI treated with percutaneous coronary intervention (early [n=5857] and delayed [>24 hours, n=15,121] intervention) at 8 tertiary cardiac centers in London.
- Funding: None.
Key results
- Patients treated within 24 hours vs those treated >24 hours were:
- slightly younger (62.8±12.8 vs 65.2±12.6 years);
- most commonly male (76% vs 72.9%);
- more frequently ventilated (2.3% vs 1.4%); and
- in cardiogenic shock (3.6% vs 1.4%) with dynamic changes on their electrocardiogram (84.5% vs 76.1%; P<.001 for all).
- At a median follow-up of 4.2 years (interquartile range, 1.8-7), 17.7% of patients had died.
- Estimated 5-year survival was 84.6% in the early intervention group vs 81% in the delayed intervention group (P<.001).
- Crude HR (delayed vs early management) for all-cause mortality was 1.23 (95% CI, 1.13-1.35; P<.001) and this increased HR remained when adjusting for age, gender and other confounders (aHR, 1.11; 95% CI, 1.002-1.23; P=.046).
- In the propensity matched cohort of 4356 patients in each group, the estimated 5-year survival was 85.2% in the early intervention group vs 83.3% in the delayed intervention group (P=.061).
Limitations
- Retrospective design.
This clinical summary first appeared on Univadis, part of the Medscape Professional Network.
