The Relevance of Interventional Time and Clinical Outcomes in Patients with NSTEMI Based on the GRACE Score

Abstract

Objective. To investigate the relevance between interventional time and clinical outcomes in non-ST-elevation myocardial infarction (NSTEMI) patients of different risk stratifications, which were divided into different groups according to GRACE scores and the time from admission to percutaneous coronary intervention (PCI). Method. Patients were grouped according to the GRACE score and the time from admission to intervention therapy. The Cox multivariate risk regression model was used to analyze the correlation between the GRACE score and the time from admission to intervention therapy with major adverse cardiovascular events (MACEs). Cox interactive item regression was also used to investigate the correlation between the time of intervention therapy and GRACE risk stratification with clinical outcomes and to evaluate the efficacy of intervention therapy in different risk stratifications of patients with NSTEMI. Results. Interactive item Cox regression analysis and subgroup analysis show that high-risk NSTEMI patients with a GRACE $\text{score}>140$ points and the time from admission to $\text{intervention}<24\text{h}$ ( $p=0.0004$ ) and 24–72 h ( $p=0.0143$ ) have interactive effects on the impact of the MACE event with the reference of intervention $\text{time}>72\text{h}$ and GRACE $\text{score}<108$ points. The time from admission to $\text{intervention}<24\text{h}$ is an independent protective factor for the occurrence of MACE events ( $\text{HR}=0.166$ , 95% CI 0.052-0.532, $p=0.0025$ ). Middle-risk patients with NSTEMI with a GRACE score of 109–140 points and the time from admission to $\text{intervention}<24\text{h}$ ( $p=0.0370$ ) and 24–72 h ( $p=0.0471$ ) have an interactive effect on the impact of MACE. The time from admission to $\text{intervention}>72\text{h}$ is an independent protective factor for the occurrence of MACE ( $\text{HR}=0.201$ , 95% CI 0.045-0.897, $p=0.0355$ ). Conclusion. The time from admission to $\text{intervention}<24\text{h}$ could effectively reduce the risk of MACE events within 1 year in high-risk patients with NSTEMI (GRACE $\text{score}>140$ points); the time from admission to $\text{intervention}>72\text{h}$ can reduce the risk of MACE events within 1 year in low-risk patients with NSTEMI (GRACE $\text{score}\le 108$ points).