NEW YORK (Reuters Health) – To reduce the risk of adverse ischemic outcomes and death, angioplasty should be done within 24 hours of presentation for non-ST-segment elevation acute coronary syndromes (NSTE-ACS), new research shows.
“There is a paucity of data on the impact of delays to percutaneous coronary intervention (PCI) in patients with NSTE-ACS undergoing an invasive management strategy,” Dr. Paul Sorajja, from the Mayo Clinic, Rochester, Minnesota, and co-authors note.
To investigate, the researchers analyzed data from subjects with NSTE-ACS in the ACUITY trial (median age 63 years, 73% male). All had PCI: 2197 within 8 hours after presentation, 2740 between 8 and 24 hours, and 2812 after more than 24 hours at elapsed.
In the Journal of the American College of Cardiology for April 6, the investigators report that patients who had PCI within 24 hours after onset had lower 30-day and 1-year rates of death, MI, and composite ischemia. For instance, 30-day mortality in the groups with PCI within 24 hours did not exceed 0.8%, whereas it was 1.7% when PCI was done later than 24 hours after onset (p < 0.0001). The corresponding 30-day rates of myocardial infarction were 5.6% and 8.0% (p < 0.0001).
A delay beyond 24 hours was particularly harmful for those at high risk (TIMI score = 5 to 7). In such patients, delayed PCI roughly doubled 30-day mortality.
“This study by the ACUITY investigators adds to the body of knowledge about how best to care for patients presenting with ACS,” Dr. David Antoniucci, from Careggi Hospital, Florence, Italy, comments in a related editorial.
“ACS patients, particularly those with positive troponins and/or dynamic electrocardiographic changes, should be immediately triaged to catheterization laboratory-based diagnosis and treatment,” he added.
J Am Coll Cardiol 2010;55:1416-1424.