Details

Autor(en) / Beteiligte

• Panoulas, Vasileios
• Rathod, Krishnaraj S.
• Jain, Ajay K.
• Firoozi, Sam
• Nevett, Joanne
• Kalra, Sundeep S.
• Malik, Iqbal S.
• Mathur, Anthony
• Redwood, Simon
• MacCarthy, Philip A.
• Wragg, Andrew
• Jones, Daniel A.
• Dalby, Miles C.

Titel

Impact of Early (≤24 h) Versus Delayed (>24 h) Intervention in Patients With Non-ST Segment Elevation Myocardial Infarction: An Observational Study of 20,882 Patients From the London Heart Attack Group

Ist Teil von

• Cardiovascular revascularization medicine, 2021-01, Vol.22, p.3-7

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2021

Link zum Volltext

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• We aimed to investigate the optimal timing of invasive coronary angiography and subsequent intervention in non-ST-segment elevation acute myocardial infarction (NSTEMI) patients. We examined the impact of early (≤24 h) versus delayed (>24 h) intervention in a large observational cohort of 20,882 consecutive NSTEMI patients treated with PCI between 2005 and 2015 at 8 tertiary cardiac centers in London (UK) using Cox-regression analysis and propensity matching. Mean age was 64.5 ± 12.7 years and 26.1% were females. A quarter (27.6%), were treated within 24 h. Patients treated within 24 h were slightly younger (62.8 ± 12.8 vs. 65.2 ± 12.6, p < 0.001), most commonly male (76% vs. 72.9%, p < 0.001) and were more frequently ventilated (2.3% vs. 1.4%, p < 0.001) and in cardiogenic shock (3.6% vs. 1.4%, p < 0.001) with dynamic changes on their ECG (84.5% vs. 76.1% p < 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 24 h was 84.6% vs. 81% for those treated >24 h following their presentation (p < 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). Notwithstanding the limitations of the retrospective design, this real-world cohort of NSTEMI patients suggests that an early intervention (≤24 h) may improve mid-term survival. •Despite randomized controlled trials in the field, the optimal timing for intervention in patients with NSTEMI has yet to be settled.•In this large real world NSTEMI registry, early intervention (≤24 h) was associated with improved mid-term survival.•If these results are confirmed in large randomized trials an early (≤24 h) invasive strategy for all NSTEMI patients should be adopted.