One-year mortality in NSTEMI patients is unaffected by timing of PCI within the first week of admission: Results of a real-world cohort analysis.

Abstract

OBJECTIVES:

We aimed to explore the impact of time to percutaneous coronary intervention (PCI) (T2P) on 1-year mortality in non-ST-elevation myocardial infarction (NSTEMI) patients.

BACKGROUND:

The current guidelines recommend an early invasive strategy for NSTEMI patients. However, impact of an early invasive strategy on mortality is a matter of debate. For that reason, real world data are of great value to determine the optimal treatment window.

METHODS:

This retrospective single center cohort study was performed in a high-volume PCI center in Amsterdam, The Netherlands. Intermediate- and high-risk NSTEMI patients undergoing PCI were included. The main discriminant was timing of PCI after admission (T2P), stratified according to different time windows (<24 h, 24-72 h, 72 h-7 days or >7 days). We analyzed 1-year mortality and the time distribution of overall survival.

RESULTS:

In total, 848 patients treated between January 1, 2016 and January 1, 2018 were included in the analysis. T2P was <24 h in 145 patients, 24-72 h in 192 patients, 72 h-7 days in 275 patients, and >7 days in 236 patients. The mean GRACE-risk score was 127.1 (SD 28.7), 130.0 (33.1), 133.8 (32.1), and 148.7 (34.6) respectively, p = <0.001. After adjusting for confounders, 1-year mortality in patients with T2P <24 h did not significantly differ when compared with T2P 24-72 h (OR = 1.08; 95% CI = 0.33-3.51) and T2P 72 h-7 days (OR 1.72; 95% CI = 0.57-5.21) but was significantly higher in T2P >7 days (OR = 3.20; 95% CI = 1.06-9.68).

CONCLUSIONS:

In an unselected cohort of patients with NSTEMI, treatment by PCI <24 h did not lead to improved survival as compared to aT2P <7 days strategy. Delay in PCI >7 days after admission resulted in worse outcome.

• Authors: Nick D Fagel, Giovanni Amoroso, Tanja Rabbering, Froukje Gescher, Maarten A Vink, Ton Slagboom, René J van der Schaaf, Jean-Paul R Herrman, Mark S Patterson, Nicola S Vos, Eva C Verbeek, Robbert J de Winter, Robert K Riezebos
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 98 Issue 5 Pg. E661-E667 (11 01 2021) ISSN: 1522-726X [Electronic] United States
• PMID: 34263520 (Publication Type: Journal Article)
• Copyright: © 2021 Wiley Periodicals LLC.

Topics

• Cohort Studies
• Humans
• Non-ST Elevated Myocardial Infarction (diagnostic imaging, therapy)
• Percutaneous Coronary Intervention
• Retrospective Studies
• Treatment Outcome