Journal article
Optimal Timing of Invasive Coronary Angiography following NSTEMI.
- Mahendiran T Department of Cardiology, Lausanne University Center Hospital, Lausanne, Switzerland.
- Nanchen D Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
- Meier D Department of Cardiology, Lausanne University Center Hospital, Lausanne, Switzerland.
- Gencer B Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland.
- Klingenberg R Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany.
- Räber L Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland.
- Carballo D Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland.
- Matter CM Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland.
- Lüscher TF Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.
- Windecker S Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Mach F Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland.
- Rodondi N Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Muller O Department of Cardiology, Lausanne University Center Hospital, Lausanne, Switzerland.
- Fournier S Department of Cardiology, Lausanne University Center Hospital, Lausanne, Switzerland.
- 2020-03-25
Published in:
- Journal of interventional cardiology. - 2020
Aged
Cardiac Catheterization
Coronary Angiography
Female
Humans
Male
Middle Aged
Non-ST Elevated Myocardial Infarction
Outcome and Process Assessment, Health Care
Proportional Hazards Models
Risk Adjustment
Switzerland
Time-to-Treatment
English
Objective
To obtain a real-world perspective of the optimal timing of angiography performed within 24 hours of admission with non-ST elevation myocardial infarction (NSTEMI).
Background
Current guidelines recommend angiography within 24 hours of hospitalisation with NSTEMI. The recent VERDICT trial found that angiography within 12 hours of admission with NSTEMI was associated with improved cardiovascular outcomes among high-risk patients. We compared the outcomes of real-world NSTEMI patients undergoing angiography within 12 hours of admission with those of patients undergoing angiography 12 to 24 hours after admission.
Methods
NSTEMI patients without life-threatening features who received angiography within 24 hours of admission were obtained from the SPUM-ACS registry, a cohort of consecutive patients admitted with acute coronary syndromes to four university hospitals in Switzerland. Cox models assessed for an association between door-to-catheter time and one-year major adverse cardiovascular events (MACE: cardiovascular mortality, myocardial infarction, and stroke).
Results
Of 2672 NSTEMI patients, 1832 met the inclusion criteria. Among them, 1464 patients underwent angiography within 12 hours (12 h group) compared with 368 patients between 12 and 24 hours (12-24 h group). Multiple logistic regression identified out-of-hours admission as the only factor associated with delayed angiography. After 2 : 1 propensity score matching, 736 patients from the 12 h group and 368 patients from the 12-24 h group demonstrated no significant difference in rates of one-year MACE (7.7% vs. 7.3%, HR: 1.050, 95% CI 0.637-1.733, p=0.847). Stratification by GRACE score (>140 vs. ≤140) found no significant reduction in MACE among high-risk patients in the 12 h group (p=0.847). Stratification by GRACE score (>140 vs. ≤140) found no significant reduction in MACE among high-risk patients in the 12 h group (.
Conclusions
In an unselected real-world cohort of NSTEMI patients, angiography within 12 hours of admission was not associated with improved one-year cardiovascular outcomes when compared with angiography 12 and 24 hours after admission, even among high-risk patients.
To obtain a real-world perspective of the optimal timing of angiography performed within 24 hours of admission with non-ST elevation myocardial infarction (NSTEMI).
Background
Current guidelines recommend angiography within 24 hours of hospitalisation with NSTEMI. The recent VERDICT trial found that angiography within 12 hours of admission with NSTEMI was associated with improved cardiovascular outcomes among high-risk patients. We compared the outcomes of real-world NSTEMI patients undergoing angiography within 12 hours of admission with those of patients undergoing angiography 12 to 24 hours after admission.
Methods
NSTEMI patients without life-threatening features who received angiography within 24 hours of admission were obtained from the SPUM-ACS registry, a cohort of consecutive patients admitted with acute coronary syndromes to four university hospitals in Switzerland. Cox models assessed for an association between door-to-catheter time and one-year major adverse cardiovascular events (MACE: cardiovascular mortality, myocardial infarction, and stroke).
Results
Of 2672 NSTEMI patients, 1832 met the inclusion criteria. Among them, 1464 patients underwent angiography within 12 hours (12 h group) compared with 368 patients between 12 and 24 hours (12-24 h group). Multiple logistic regression identified out-of-hours admission as the only factor associated with delayed angiography. After 2 : 1 propensity score matching, 736 patients from the 12 h group and 368 patients from the 12-24 h group demonstrated no significant difference in rates of one-year MACE (7.7% vs. 7.3%, HR: 1.050, 95% CI 0.637-1.733, p=0.847). Stratification by GRACE score (>140 vs. ≤140) found no significant reduction in MACE among high-risk patients in the 12 h group (p=0.847). Stratification by GRACE score (>140 vs. ≤140) found no significant reduction in MACE among high-risk patients in the 12 h group (.
Conclusions
In an unselected real-world cohort of NSTEMI patients, angiography within 12 hours of admission was not associated with improved one-year cardiovascular outcomes when compared with angiography 12 and 24 hours after admission, even among high-risk patients.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1155/2020/8513257
- PMID 32206045
- Persistent URL
- https://folia.unifr.ch/global/documents/33861
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