Optimal Timing of Invasive Coronary Angiography following NSTEMI

Author:

Mahendiran Thabo1ORCID,Nanchen David2,Meier David1,Gencer Baris3,Klingenberg Roland4,Räber Lorenz5,Carballo David3,Matter Christian M.5,Lüscher Thomas F.67,Windecker Stephan8,Mach François3ORCID,Rodondi Nicolas910,Muller Olivier1,Fournier Stephane111ORCID

Affiliation:

1. Department of Cardiology, Lausanne University Center Hospital, Lausanne, Switzerland

2. Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland

3. Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland

4. Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany

5. Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland

6. Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland

7. Imperial College and Royal Brompton & Harefield Hospitals, London, UK

8. Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

9. Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

10. Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland

11. Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini, 5, 80131 Naples, Italy

Abstract

Objective. To obtain a real-world perspective of the optimal timing of angiography performed within 24 hours of admission with non-ST elevation myocardial infarction (NSTEMI). Background. Current guidelines recommend angiography within 24 hours of hospitalisation with NSTEMI. The recent VERDICT trial found that angiography within 12 hours of admission with NSTEMI was associated with improved cardiovascular outcomes among high-risk patients. We compared the outcomes of real-world NSTEMI patients undergoing angiography within 12 hours of admission with those of patients undergoing angiography 12 to 24 hours after admission. Methods. NSTEMI patients without life-threatening features who received angiography within 24 hours of admission were obtained from the SPUM-ACS registry, a cohort of consecutive patients admitted with acute coronary syndromes to four university hospitals in Switzerland. Cox models assessed for an association between door-to-catheter time and one-year major adverse cardiovascular events (MACE: cardiovascular mortality, myocardial infarction, and stroke). Results. Of 2672 NSTEMI patients, 1832 met the inclusion criteria. Among them, 1464 patients underwent angiography within 12 hours (12 h group) compared with 368 patients between 12 and 24 hours (12–24 h group). Multiple logistic regression identified out-of-hours admission as the only factor associated with delayed angiography. After 2 : 1 propensity score matching, 736 patients from the 12 h group and 368 patients from the 12–24 h group demonstrated no significant difference in rates of one-year MACE (7.7% vs. 7.3%, HR: 1.050, 95% CI 0.637–1.733, p=0.847). Stratification by GRACE score (>140 vs. ≤140) found no significant reduction in MACE among high-risk patients in the 12 h group (p for interaction = 0.601). Conclusions. In an unselected real-world cohort of NSTEMI patients, angiography within 12 hours of admission was not associated with improved one-year cardiovascular outcomes when compared with angiography 12 and 24 hours after admission, even among high-risk patients.

Funder

Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung

Publisher

Hindawi Limited

Subject

Cardiology and Cardiovascular Medicine,Radiology Nuclear Medicine and imaging

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