Optimal Timing of Invasive Coronary Angiography following NSTEMI.

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License: CC BY 4.0
Serval ID
serval:BIB_077F882FB39B
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Optimal Timing of Invasive Coronary Angiography following NSTEMI.
Journal
Journal of interventional cardiology
Author(s)
Mahendiran T., Nanchen D., Meier D., Gencer B., Klingenberg R., Räber L., Carballo D., Matter C.M., Lüscher T.F., Windecker S., Mach F., Rodondi N., Muller O., Fournier S.
ISSN
1540-8183 (Electronic)
ISSN-L
0896-4327
Publication state
Published
Issued date
2020
Peer-reviewed
Oui
Volume
2020
Pages
8513257
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
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).
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.
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).
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=0.847). Stratification by GRACE score (>140 vs. ≤140) found no significant reduction in MACE among high-risk patients in the 12 h group (.
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.
Keywords
Aged, Cardiac Catheterization/methods, Cardiac Catheterization/statistics & numerical data, Coronary Angiography/methods, Coronary Angiography/statistics & numerical data, Female, Humans, Male, Middle Aged, Non-ST Elevated Myocardial Infarction/complications, Non-ST Elevated Myocardial Infarction/diagnosis, Non-ST Elevated Myocardial Infarction/epidemiology, Non-ST Elevated Myocardial Infarction/therapy, Outcome and Process Assessment, Health Care, Proportional Hazards Models, Risk Adjustment/methods, Switzerland/epidemiology, Time-to-Treatment/standards
Pubmed
Web of science
Open Access
Yes
Create date
01/04/2020 18:50
Last modification date
15/01/2021 7:08
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