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Early coronary angiography in NSTEMI: a regional Victorian perspective

journal contribution
posted on 2024-08-26, 06:51 authored by A Ganes, J Henderson, R Samuel, L Segan, Chin HiewChin Hiew, A Hutchison
AbstractBackgroundCurrent guidelines highlight a paucity of evidence guiding optimal timing for non‐ST‐elevation myocardial infarction (NSTEMI) in high‐risk and non‐high‐risk cases.AimWe assessed long‐term major adverse cardiovascular events (MACEs) in NSTEMI patients undergoing early (<24 h) versus delayed (>24 h) coronary angiography at 6 years. Secondary end‐points included all‐cause mortality and cumulative MACE outcomes.MethodsBaseline characteristics and clinical outcomes were assessed among 355 patients presenting to a tertiary regional hospital between 2017 and 2018. Cox proportional hazard models were generated for MACE and all‐cause mortality outcomes, adjusting for the Global Registry of Acute Coronary Events (GRACE) score, patient demographics, biomarkers and comorbidities.ResultsTwo hundred and seventy patients were included; 147 (54.4%) and 123 (45.6%) underwent early and delayed coronary angiography respectively. Median time to coronary angiography was 13.3 and 45.4 h respectively. At 6 years, 103 patients (38.1%) experienced MACE; 41 in the early group and 62 in the delayed group (hazard ratio (HR) = 2.23; 95% confidence interval (CI) = 1.50–3.31). After multivariable adjustment, the delayed group had higher rates of MACE (HR = 1.79; 95% CI = 1.19–2.70), all‐cause mortality (HR = 2.76; 95% CI = 1.36–5.63) and cumulative MACE (incidence rate ratio = 1.54; 95% CI = 1.12–2.11). Subgroup analysis of MACE outcomes in rural and weekend NSTEMI presentations was not significant between early and delayed coronary angiography (HR = 1.49; 95% CI = 0.83–2.62).ConclusionHigher MACE rates in the delayed intervention group suggest further investigation is needed. Randomised control trials would be well suited to assess the role of early invasive intervention across all NSTEMI risk groups.

History

Journal

Internal Medicine Journal

Pagination

1-9

Location

London, Eng.

ISSN

1444-0903

eISSN

1445-5994

Language

en

Publication classification

C1.1 Refereed article in a scholarly journal

Publisher

Wiley