P5523Impact of early coronary angiography in contemporary non-ST-segment elevation myocardial infarction patients

• Published in: European heart journal Vol. 40; no. Supplement_1
• Main Authors: Abou Jokh Casas, C, Alvarez Alvarez, B, Cordero, A, Garcia Acuna, J M, Rigueiro Veloso, P, Agra Bermejo, R, Roman Rego, A, Cid Alvarez, B, Alvarez Alvarez, L, Martinez Gomez, A, Antunez Muino, P, Gonzalez Ferrero, T, Iglesias Alvarez, D, Gonzalez Juanatey, J R
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01.10.2019
• Subjects: Coronary Artery Disease: Treatment, Revascularization
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehz746.0471

Abstract Background An early invasive strategy in non-ST segment elevation myocardial infarction is recommended. Objective This study sought to analyse association of early coronary angiography with all-cause mortality and cardiovascular mortality in patients with non-ST segment elevation myocardial infarction (NSTEMI) using a large contemporary cohort of patients with NSTEMI from two Spanish tertiary hospitals. Methods This retrospective observational study included 5673 consecutive NSTEMI patients from two Spanish hospitals between the years 2005 and 2016. A propensity score matching analysis was applied to obtain a well-balanced subset of patients with the same probability of early revascularization strategy (first 24-hours after hospital admission), resulting in 3780 patients. Cox regression models performed survival analyses once proportional risk test were verified. Results Among the study participants, 2087 patients (40.9%) underwent early invasive coronary angiography. The median follow-up was 59.0 months (interquartile range 25.0–80.0 months). All- cause mortality was 19.0%, cardiovascular mortality was 12.8%, and 51.1% patients experienced at least one MACE in the follow-up. After propensity score matching, an early strategy was associated with a significantly lower mortality (HR: 0.79; 95% CI 0.62–0.98) in high-risk (GRACE>140) NSTEMI patients. An early strategy showed a non-significant inverse tendency in patients with GRACE score <140. CV mortality and all-cause mortality Conclusion In high-risk NSTEMI patients in a contemporary real-world registry, early coronary angiography may be associated with reduced all-cause mortality and cardiovascular mortality in the long-term follow-up.