fr
Article scientifique
Accès libre
Anglais

Optimal timing of invasive coronary angiography following NSTEMI

Publié dansJournal of interventional cardiology, vol. 2020, 8513257
Date de publication2020
Date de mise en ligne2020-03-03
Résumé

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.

eng
Mots-clés
  • Aged
  • Cardiac Catheterization / methods
  • Cardiac Catheterization / statistics & numerical data
  • Coronary Angiography / methods
  • Coronary Angiography / statistics & numerical data
  • Female
  • Humans
  • Male
  • Middle Aged
  • Non-ST Elevated Myocardial Infarction / complications
  • Non-ST Elevated Myocardial Infarction / diagnosis
  • Non-ST Elevated Myocardial Infarction / epidemiology
  • Non-ST Elevated Myocardial Infarction / therapy
  • Outcome and Process Assessment, Health Care
  • Proportional Hazards Models
  • Risk Adjustment / methods
  • Switzerland / epidemiology
  • Time-to-Treatment / standards
Financement
  • Swiss National Science Foundation - Inflammation and acute coronary syndrome (ACS) - novel strategies for prevention and clinical management
Citation (format ISO)
MAHENDIRAN, Thabo et al. Optimal timing of invasive coronary angiography following NSTEMI. In: Journal of interventional cardiology, 2020, vol. 2020, p. 8513257. doi: 10.1155/2020/8513257
Fichiers principaux (1)
Article (Published version)
Identifiants
ISSN du journal0896-4327
146vues
26téléchargements

Informations techniques

Création30/06/2022 09:28:00
Première validation30/06/2022 09:28:00
Heure de mise à jour16/03/2023 07:30:28
Changement de statut16/03/2023 07:30:27
Dernière indexation12/02/2024 12:25:27
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack