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Clinical impact of immediate invasive strategy in patients with non-ST-segment elevation myocardial infarction

Authors
Sim, Doo SunJeong, Myung HoAhn, YoungkeunKim, Young JoChae, Shung ChullHong, Taek JongSeong, In WhanChae, Jei KeonKim, Chong JinCho, Myeong ChanRha, Seung-WoonBae, Jang HoSeung, Ki BaePark, Seung Jung
Issue Date
15-10월-2016
Publisher
ELSEVIER IRELAND LTD
Keywords
Myocardial infarction; Percutaneous coronary intervention; Bleeding
Citation
INTERNATIONAL JOURNAL OF CARDIOLOGY, v.221, pp.937 - 943
Indexed
SCIE
SCOPUS
Journal Title
INTERNATIONAL JOURNAL OF CARDIOLOGY
Volume
221
Start Page
937
End Page
943
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/87174
DOI
10.1016/j.ijcard.2016.07.128
ISSN
0167-5273
Abstract
Background: Immediate invasive approach for non-ST-segment elevation myocardial infarction (NSTEMI) may permit treatment of the underlying plaque rupture as early as possible with subsequent reduction of death and myocardial infarction (MI). We sought to assess clinical impact of immediate percutaneous coronary intervention (PCI) for NSTEMI. Methods: A total of 6134 NSTEMI patients undergoing PCI from the Korea Acute Myocardial Infarction Registry were divided into group 1 (immediate PCI within 4 h, n = 1132) and group 2 (non-immediate PCI after 4 h, n = 5002). Propensity-matched 12-month clinical outcome was compared. Results: In all patients and propensity-matched cohort (n = 1131 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 (MACE: composite of death, MI, target-vessel revascularization, and coronary artery bypass graft surgery). In 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. Conclusions: Immediate PCI for patients with NSTEMI was associated with lower pre-PCI culprit vessel patency and not with improved 12-month clinical outcome. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
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