Optimal timing of percutaneous coronary intervention for non-ST elevated myocardial infarction with congestive heart failure.

Autor: Lim Y; Department of Cardiovascular Medicine, Chonnam National University Medical School/Hospital, Gwangju, South Korea., Kim MC; Department of Cardiovascular Medicine, Chonnam National University Medical School/Hospital, Gwangju, South Korea., Ahn JH; Department of Cardiovascular Medicine, Chonnam National University Medical School/Hospital, Gwangju, South Korea., Lee SH; Department of Cardiovascular Medicine, Chonnam National University Medical School/Hospital, Gwangju, South Korea., Hyun DY; Department of Cardiovascular Medicine, Chonnam National University Medical School/Hospital, Gwangju, South Korea., Cho KH; Department of Cardiovascular Medicine, Chonnam National University Medical School/Hospital, Gwangju, South Korea., Sim DS; Department of Cardiovascular Medicine, Chonnam National University Medical School/Hospital, Gwangju, South Korea., Hong YJ; Department of Cardiovascular Medicine, Chonnam National University Medical School/Hospital, Gwangju, South Korea., Kim JH; Department of Cardiovascular Medicine, Chonnam National University Medical School/Hospital, Gwangju, South Korea., Jeong MH; Department of Cardiovascular Medicine, Chonnam National University Medical School/Hospital, Gwangju, South Korea., Choi IJ; Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea., Choo EH; Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea., Lim S; Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea., Hwang BH; Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea., Park MW; Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea., Kim CJ; Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea., Park CS; Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea., Kim HY; Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea., Chang K; Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea., Ahn Y; Department of Cardiovascular Medicine, Chonnam National University Medical School/Hospital, Gwangju, South Korea. Electronic address: cecilyk@hanmail.net.
Jazyk: angličtina
Zdroj: Cardiovascular revascularization medicine : including molecular interventions [Cardiovasc Revasc Med] 2024 Oct; Vol. 67, pp. 87-93. Date of Electronic Publication: 2024 Apr 25.
DOI: 10.1016/j.carrev.2024.04.295
Abstrakt: Objectives: This study investigated the optimal timing for percutaneous coronary intervention (PCI) in patients with NSTEMI complicated by heart failure (HF).
Methods: In total, 762 patients with NSTEMI and HF in a multicenter, prospective registry in South Korea were classified according to the Killip classification (Killip class 2, n = 414 and Killip class 3, n = 348) and underwent early (within 24 h) and delayed (after 24 h) PCI. The primary outcome was all-cause mortality which was further analyzed with landmark analysis with two months as a cut-off. Secondary outcomes were cardiovascular death, in-hospital cardiogenic shock (CS), readmission due to HF, and acute myocardial infarction during follow-up.
Results: Delayed PCI was associated with lower rates of 2-month mortality (6.1 % vs. 15.8 %, p = 0.007) and in-hospital CS (4.3 % vs. 14.1 %, p = 0.003), along with lower risks of 2-month mortality (hazard ratio [HR] = 0.38, 95 % confidence interval [CI] = 0.18-0.83, p = 0.014), in-hospital CS (HR = 0.29, 95 % CI = 0.12-0.71, p = 0.006) in multivariate Cox models of Killip class 3 patients. There was no statistical difference of incidence and risk of all predefined outcomes according to varying timing of PCI in Killip 2 patients.
Conclusions: Based on these results, the timing of PCI in patients with NSTEMI complicated by HF should be determined based on HF severity. Delayed PCI should be considered in patients with NSTEMI and more severe HF.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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