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.

Autor: Panoulas V; Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Hill End Road, Middlesex UB9 6JH, UK. Electronic address: v.panoulas@imperial.ac.uk., Rathod KS; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK., Jain AK; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK., Firoozi S; Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK., Nevett J; London Ambulance Service NHS Trust, London, UK., Kalra SS; Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK., Malik IS; Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, Du Cane Road, London W120NN, UK., Mathur A; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK., Redwood S; Department of Cardiology, St Thomas' NHS Foundation Trust, Guys & St. Thomas Hospital, Westminster Bridge Rd, London SE17EH, UK., MacCarthy PA; Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, Denmark Hill, UK., Wragg A; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK., Jones DA; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK., Dalby MC; Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Hill End Road, Middlesex UB9 6JH, UK.
Jazyk: angličtina
Zdroj: Cardiovascular revascularization medicine : including molecular interventions [Cardiovasc Revasc Med] 2021 Jan; Vol. 22, pp. 3-7. Date of Electronic Publication: 2020 Jun 03.
DOI: 10.1016/j.carrev.2020.06.001
Abstrakt: Introduction: We aimed to investigate the optimal timing of invasive coronary angiography and subsequent intervention in non-ST-segment elevation acute myocardial infarction (NSTEMI) patients.
Methods: 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.
Results: 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).
Conclusions: 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.
Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: