Abstract 20775: Optimal Timing of Invasive Strategy in Stable Non-ST-Segment Elevation Myocardial Infarction: Impact of Immediate Intervention
BackgroundThe optimal timing of intervention in non-ST-elevation myocardial infarction (NSTEMI) remains controversial. We sought to assess impact of immediate percutaneous coronary intervention (PCI) for NSTEMI.Methods6,134 NSTEMI patients undergoing PCI from the Korea Acute Myocardial Infarction Re...
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Published in | Circulation (New York, N.Y.) Vol. 134; no. Suppl_1 Suppl 1; p. A20775 |
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Main Authors | , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
by the American College of Cardiology Foundation and the American Heart Association, Inc
11.11.2016
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Abstract | BackgroundThe optimal timing of intervention in non-ST-elevation myocardial infarction (NSTEMI) remains controversial. We sought to assess impact of immediate percutaneous coronary intervention (PCI) for NSTEMI.Methods6,134 NSTEMI patients undergoing PCI from the Korea Acute Myocardial Infarction Registry were divided into group 1 (immediate PCI within 4 h, n = 1,132) and group 2 (deferred PCI after 4 h, n = 5,002). Patients with recurrent or refractory ischemia, systolic blood pressure <90 mmHg, Killip class ≥3, ventricular arrhythmia, cardiac arrest, or mechanical complications were excluded. Propensity-matched 12-month clinical outcome was compared between the groups and according to time to PCI.ResultsIn all patients and propensity-matched cohort (n = 1,131 in each group), group 1 had higher peak troponin level, higher rate of pre-PCI Thrombolysis In Myocardial Infarction (TIMI) grade 0 or 1, higher use of glycoprotein IIb/IIIa inhibitor, and lower use of unfractionated heparin and nitrates. In all patients, 12-month rates of MI and death/MI were higher in group 1. No differences were observed in 12-month death and major adverse cardiac events (MACEcomposite of death, MI, target-vessel revascularization, and coronary artery bypass graft surgery). In the propensity-matched cohort, no significant differences were observed in 12-month rates of death, MI, death/MI or MACE. However, group 1 had less major bleeding (0.8% vs. 3.0%, p = 0.024) and shorter hospital stay. In the propensity-matched cohort, the effect of PCI on 12-month outcome showed a U-shaped relationship with time to PCIrates of MI and death/MI (≤4 h, 4-12 h, 12-24 h, 24-72 h, >72 h after arrival) were 2.7%, 1.3%, 1.1%, 1.9%, 2.2% and 6.5%, 4.2%, 3.9%, 5.2%, 6.1%, respectively. PCI 4-12 h and 12-24 h after arrival was associated with lower risk of 12-month MI (hazard ratio [HR]0.49, 95% confidence interval [CI]0.25 to 0.93, p = 0.03 and HR0.40, 95% CI0.22 to 0.72, p = 0.002) and death/MI (HR0.64, 95% CI0.44 to 0.93, p = 0.02 and HR0.60, 95% CI0.43 to 0.84, p = 0.003), respectively.ConclusionsImmediate PCI for stable NSTEMI did not confer an advantage with respect to hard clinical endpoints at 12 months. PCI within 4-24 h after arrival was associated with lower risk of adverse events. |
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AbstractList | BackgroundThe optimal timing of intervention in non-ST-elevation myocardial infarction (NSTEMI) remains controversial. We sought to assess impact of immediate percutaneous coronary intervention (PCI) for NSTEMI.Methods6,134 NSTEMI patients undergoing PCI from the Korea Acute Myocardial Infarction Registry were divided into group 1 (immediate PCI within 4 h, n = 1,132) and group 2 (deferred PCI after 4 h, n = 5,002). Patients with recurrent or refractory ischemia, systolic blood pressure <90 mmHg, Killip class ≥3, ventricular arrhythmia, cardiac arrest, or mechanical complications were excluded. Propensity-matched 12-month clinical outcome was compared between the groups and according to time to PCI.ResultsIn all patients and propensity-matched cohort (n = 1,131 in each group), group 1 had higher peak troponin level, higher rate of pre-PCI Thrombolysis In Myocardial Infarction (TIMI) grade 0 or 1, higher use of glycoprotein IIb/IIIa inhibitor, and lower use of unfractionated heparin and nitrates. In all patients, 12-month rates of MI and death/MI were higher in group 1. No differences were observed in 12-month death and major adverse cardiac events (MACEcomposite of death, MI, target-vessel revascularization, and coronary artery bypass graft surgery). In the propensity-matched cohort, no significant differences were observed in 12-month rates of death, MI, death/MI or MACE. However, group 1 had less major bleeding (0.8% vs. 3.0%, p = 0.024) and shorter hospital stay. In the propensity-matched cohort, the effect of PCI on 12-month outcome showed a U-shaped relationship with time to PCIrates of MI and death/MI (≤4 h, 4-12 h, 12-24 h, 24-72 h, >72 h after arrival) were 2.7%, 1.3%, 1.1%, 1.9%, 2.2% and 6.5%, 4.2%, 3.9%, 5.2%, 6.1%, respectively. PCI 4-12 h and 12-24 h after arrival was associated with lower risk of 12-month MI (hazard ratio [HR]0.49, 95% confidence interval [CI]0.25 to 0.93, p = 0.03 and HR0.40, 95% CI0.22 to 0.72, p = 0.002) and death/MI (HR0.64, 95% CI0.44 to 0.93, p = 0.02 and HR0.60, 95% CI0.43 to 0.84, p = 0.003), respectively.ConclusionsImmediate PCI for stable NSTEMI did not confer an advantage with respect to hard clinical endpoints at 12 months. PCI within 4-24 h after arrival was associated with lower risk of adverse events. |
Author | Kim, Min Chul Ahn, Youngkeun Seung, Ki Bae Park, Seung Jung Hong, Taek Jong Seong, In Whan Cho, Myeong Chan Kim, Chong Jin Jeong, Myung Ho Sim, Doo Sun Rha, Seung-Woon Chae, Jei Keon Chae, Shung Chull Bae, Jang Ho Kim, Young Jo |
AuthorAffiliation | 1Cardiology, Chonnam National Univ Hosp, Gwangju, Korea, Republic of 2Cardiology, Yeungnam Univ Hosp, Daegu, Korea, Republic of 3Cardiology, Kyungpuk National Univ Hosp, Daegu, Korea, Republic of 4Cardiology, Busan National Univ Hosp, Busan, Korea, Republic of 5Cardiology, Chungnam National Univ Hosp, Daejon, Korea, Republic of 6Cardiology, Chunbuk National Univ Hosp, Jeonju, Korea, Republic of 7Cardiology, Kyung Hee Univ Hosp, Seoul, Korea, Republic of 8Cardiology, Chungbuk National Univ Hosp, Cheongju, Korea, Republic of 9Cardiology, Korea Univ Guro Hosp, Seoul, Korea, Republic of 10Cardiology, Konyang Univ Hosp, Daejon, Korea, Republic of 11Cardiology, Catholic Univ Hosp, Seoul, Korea, Republic of 12Cardiology, Asan Med Cntr, Seoul, Korea, Republic of |
AuthorAffiliation_xml | – name: 1Cardiology, Chonnam National Univ Hosp, Gwangju, Korea, Republic of 2Cardiology, Yeungnam Univ Hosp, Daegu, Korea, Republic of 3Cardiology, Kyungpuk National Univ Hosp, Daegu, Korea, Republic of 4Cardiology, Busan National Univ Hosp, Busan, Korea, Republic of 5Cardiology, Chungnam National Univ Hosp, Daejon, Korea, Republic of 6Cardiology, Chunbuk National Univ Hosp, Jeonju, Korea, Republic of 7Cardiology, Kyung Hee Univ Hosp, Seoul, Korea, Republic of 8Cardiology, Chungbuk National Univ Hosp, Cheongju, Korea, Republic of 9Cardiology, Korea Univ Guro Hosp, Seoul, Korea, Republic of 10Cardiology, Konyang Univ Hosp, Daejon, Korea, Republic of 11Cardiology, Catholic Univ Hosp, Seoul, Korea, Republic of 12Cardiology, Asan Med Cntr, Seoul, Korea, Republic of |
Author_xml | – sequence: 1 givenname: Doo surname: Sim middlename: Sun fullname: Sim, Doo Sun organization: 1Cardiology, Chonnam National Univ Hosp, Gwangju, Korea, Republic of 2Cardiology, Yeungnam Univ Hosp, Daegu, Korea, Republic of 3Cardiology, Kyungpuk National Univ Hosp, Daegu, Korea, Republic of 4Cardiology, Busan National Univ Hosp, Busan, Korea, Republic of 5Cardiology, Chungnam National Univ Hosp, Daejon, Korea, Republic of 6Cardiology, Chunbuk National Univ Hosp, Jeonju, Korea, Republic of 7Cardiology, Kyung Hee Univ Hosp, Seoul, Korea, Republic of 8Cardiology, Chungbuk National Univ Hosp, Cheongju, Korea, Republic of 9Cardiology, Korea Univ Guro Hosp, Seoul, Korea, Republic of 10Cardiology, Konyang Univ Hosp, Daejon, Korea, Republic of 11Cardiology, Catholic Univ Hosp, Seoul, Korea, Republic of 12Cardiology, Asan Med Cntr, Seoul, Korea, Republic of – sequence: 2 givenname: Min surname: Kim middlename: Chul fullname: Kim, Min Chul – sequence: 3 givenname: Myung surname: Jeong middlename: Ho fullname: Jeong, Myung Ho – sequence: 4 givenname: Youngkeun surname: Ahn fullname: Ahn, Youngkeun – sequence: 5 givenname: Young surname: Kim middlename: Jo fullname: Kim, Young Jo – sequence: 6 givenname: Shung surname: Chae middlename: Chull fullname: Chae, Shung Chull – sequence: 7 givenname: Taek surname: Hong middlename: Jong fullname: Hong, Taek Jong – sequence: 8 givenname: In surname: Seong middlename: Whan fullname: Seong, In Whan – sequence: 9 givenname: Jei surname: Chae middlename: Keon fullname: Chae, Jei Keon – sequence: 10 givenname: Chong surname: Kim middlename: Jin fullname: Kim, Chong Jin – sequence: 11 givenname: Myeong surname: Cho middlename: Chan fullname: Cho, Myeong Chan – sequence: 12 givenname: Seung-Woon surname: Rha fullname: Rha, Seung-Woon – sequence: 13 givenname: Jang surname: Bae middlename: Ho fullname: Bae, Jang Ho – sequence: 14 givenname: Ki surname: Seung middlename: Bae fullname: Seung, Ki Bae – sequence: 15 givenname: Seung surname: Park middlename: Jung fullname: Park, Seung Jung |
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Title | Abstract 20775: Optimal Timing of Invasive Strategy in Stable Non-ST-Segment Elevation Myocardial Infarction: Impact of Immediate Intervention |
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