The outcomes in patients with acute non-ST elevation myocardial infarction treated with percutaneous coronary intervention within 24h after onset, delayed percutaneous coronary intervention or optimal medical therapy at initial hospitalization and during one-year follow-up: the experience from the Croatian branch of the ISACS-CT Registry

    Keywords

    acute coronary syndrome, percutaneous coronary intervention

    DOI

    https://doi.org/10.15836/ccar2018.311

    Full Text

    Background and aim: Previous studies found conflicting results on the effects of earlier invasive intervention in a heterogeneous population of acute non-ST elevation myocardial infarction (NSTEMI) ( 1 ). Our aim was to explore in-hospital and 1-year follow-up outcomes in NSTEMI patients (pts) treated with PCI in the first 24 h, PCI after 24 h and optimal medical therapy (OMT). Patients and Methods: From January 2012 to October 2017, 1898 pts were enrolled in the Croatian arm of the ISACS-CT registry (NCT01218776) 36% (n=685) with NSTEMI, of which 675 had available data on treatment modality. One-year follow-up was available in 217 (32%) of the NSTEMI patients. Results: In 57% (n=386) of pts PCI was done within 24 h from symptoms onset, in 14% (n=95) after 24 h, while 29% (n=194) were discharged with OMT. Pts in the OMT group were significantly older, with more comorbidities, with a lower left ventricular ejection fraction (LVEF) value at discharge and greater delay from symptom onset to hospitalization ( Table 1 ). Pts with PCI performed within 24 h had the greatest frequency of PCI reintervention during follow-up (PCI ≤ 24 h; PCI > 24 h; OMT: 15%; 3%; 0%; p=0.008). In-hospital mortality did not significantly differ between the groups (PCI ≤ 24 h; PCI > 24 h; OMT: 2.5%; 3.5%; 4.6%; p=0.220), yet in those with data on 1-year mortality ( Figure 1 ), this was the highest in the OMT group (PCI ≤ 24 h; PCI > 24 h; OMT: 3.3%; 8.3%; 19.4%; p=0.005). Univariable regression suggested that PCI < 24 h significantly reduced mortality at 1-year follow-up (OR 0.14, 95% CI 0.04-0.51, p=0.03). The effect was lost after adjustment for age, LVEF and chronic kidney disease (CKD) in a multivariable model, which proved LVEF (OR 0.95, 95% CI 0.90-0.99, p=0.049) and CKD (OR 6.31, 95% CI 1.67-23.8, p=0.007) as the only significant predictors of survival. Patient survival. OMT – optimal medical therapy, PCI – percutaneous coronary intervention. Conclusion: NSTEMI patients in the three treatment groups had different risk profiles at hospitalization, the OMT group being burdened with most comorbidities. The therapy of choice did not seem to have a significant influence on in-hospital or 1-year survival. Due to their higher risk profile, the pts treated with OMT had significantly lower 1-year survival, with lower LVEF and higher rate of CKD as predictors of primary outcome.

    Cardiologia Croatica
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    The outcomes in patients with acute non-ST elevation myocardial infarction treated with percutaneous coronary intervention within 24h after onset, delayed percutaneous coronary intervention or optimal medical therapy at initial hospitalization and during one-year follow-up: the experience from the Croatian branch of the ISACS-CT Registry

    Extended Abstract
    Issue11-12
    Published
    Pages311-312
    PDF via DOIhttps://doi.org/10.15836/ccar2018.311
    acute coronary syndrome
    percutaneous coronary intervention

    Full Text

    Background and aim: Previous studies found conflicting results on the effects of earlier invasive intervention in a heterogeneous population of acute non-ST elevation myocardial infarction (NSTEMI) ( 1 ). Our aim was to explore in-hospital and 1-year follow-up outcomes in NSTEMI patients (pts) treated with PCI in the first 24 h, PCI after 24 h and optimal medical therapy (OMT). Patients and Methods: From January 2012 to October 2017, 1898 pts were enrolled in the Croatian arm of the ISACS-CT registry (NCT01218776) 36% (n=685) with NSTEMI, of which 675 had available data on treatment modality. One-year follow-up was available in 217 (32%) of the NSTEMI patients. Results: In 57% (n=386) of pts PCI was done within 24 h from symptoms onset, in 14% (n=95) after 24 h, while 29% (n=194) were discharged with OMT. Pts in the OMT group were significantly older, with more comorbidities, with a lower left ventricular ejection fraction (LVEF) value at discharge and greater delay from symptom onset to hospitalization ( Table 1 ). Pts with PCI performed within 24 h had the greatest frequency of PCI reintervention during follow-up (PCI ≤ 24 h; PCI > 24 h; OMT: 15%; 3%; 0%; p=0.008). In-hospital mortality did not significantly differ between the groups (PCI ≤ 24 h; PCI > 24 h; OMT: 2.5%; 3.5%; 4.6%; p=0.220), yet in those with data on 1-year mortality ( Figure 1 ), this was the highest in the OMT group (PCI ≤ 24 h; PCI > 24 h; OMT: 3.3%; 8.3%; 19.4%; p=0.005). Univariable regression suggested that PCI < 24 h significantly reduced mortality at 1-year follow-up (OR 0.14, 95% CI 0.04-0.51, p=0.03). The effect was lost after adjustment for age, LVEF and chronic kidney disease (CKD) in a multivariable model, which proved LVEF (OR 0.95, 95% CI 0.90-0.99, p=0.049) and CKD (OR 6.31, 95% CI 1.67-23.8, p=0.007) as the only significant predictors of survival. Patient survival. OMT – optimal medical therapy, PCI – percutaneous coronary intervention. Conclusion: NSTEMI patients in the three treatment groups had different risk profiles at hospitalization, the OMT group being burdened with most comorbidities. The therapy of choice did not seem to have a significant influence on in-hospital or 1-year survival. Due to their higher risk profile, the pts treated with OMT had significantly lower 1-year survival, with lower LVEF and higher rate of CKD as predictors of primary outcome.