Contemporary practice pattern of revascularization in a large tertiary care referral center in non‐ST elevation myocardial infarction: A propensity‐matched 10‐year experience

• Published in: Catheterization and cardiovascular interventions Vol. 93; no. 2; pp. 256 - 263
• Main Authors: Shetabi, Kambiz, Ullah, Rafath, Patel, Raj, Wilson, Thomas, Siddiqua, Tasneem, Olet, Susan, Ammar, Khawaja Afzal, Jahangir, Arshad, Allaqaband, Suhail Q., Bajwa, Tanvir, Jan, M. Fuad
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.02.2019; Wiley Subscription Services, Inc
• Subjects: ACS/NSTEMI; Aged; Cerebral infarction; Congestive heart failure; Death; delayed intervention; Early intervention; Female; health care outcomes; Heart attacks; Heart failure; Heart Failure - mortality; Humans; Male; Males; Middle Aged; Myocardial infarction; Non-ST Elevated Myocardial Infarction - diagnosis; Non-ST Elevated Myocardial Infarction - mortality; Non-ST Elevated Myocardial Infarction - therapy; Non‐ST‐segment myocardial infarction; Patients; percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - mortality; Percutaneous Coronary Intervention - trends; Practice Patterns, Physicians' - trends; propensity‐matched; Recurrence; Referral and Consultation - trends; Reperfusion; Risk Assessment; Risk Factors; Stroke; Stroke - mortality; Tertiary Care Centers - trends; Time Factors; Time-to-Treatment - trends; Treatment Outcome; health care outcomes; percutaneous coronary intervention; early intervention; ACS/NSTEMI; Non-ST-segment myocardial infarction; delayed intervention; propensity-matched
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.27839

Objectives We sought to compare the effects of early versus delayed percutaneous coronary intervention (PCI) on the outcomes at 1 year in patients presenting with non‐ST‐segment elevation myocardial infarction (NSTEMI). Background Prompt reperfusion in NSTEMI remains controversial. Randomized studies have shown conflicting results regarding the benefits of early intervention versus delayed intervention (defined as intervention performed within 24 hr vs. 24–72 hr of presentation, respectively). This study was conducted to determine the clinical outcomes post PCI in a large tertiary care center. Methods A propensity‐matched group of 1,640 NSTEMI patients [62.4% males (n = 1,023), median age 65 years] was studied for a composite of death, myocardial infarction (MI), stroke, and heart failure in 1 year as a primary endpoint after PCI. Patients were divided into an early intervention group (EIG) and delayed intervention group (DIG). Timing of PCI was determined by the treating interventional cardiologist. Results The primary outcome was significantly lower in the EIG than DIG (20.4% vs. 24.9%, P = 0.029), which was mainly derived from mortality benefit in the EIG. There was no difference in occurrence of death, MI, stroke, or heart failure between the groups at 30 days. Conclusions An earlier PCI in patients with NSTEMI is associated with a significant reduction in the composite outcome of death, MI, heart failure, or stroke at 1 year compared with delayed PCI. Based on this large cohort of patients from a real‐world referral center, contemporary reperfusion practices in NSTEMI may need to be re‐examined with a bias toward early intervention.