September 18, 2008Heart
Delay to angiography and outcomes following presentation with high-risk, non-ST-elevation acute coronary syndromes: results from the Global Registry of Acute Coronary Events
Key result
In patients with high-risk NSTE-ACS, delayed angiography (>72 hours) was associated with a lower rate of MACE compared to no angiography (18.9% vs 22.2%, p=0.015).
Why the study?
Does delayed angiography (>72 hours) worsen clinical outcomes in patients with high-risk NSTE-ACS compared to early or no angiography?
Population
23,396 patients with high-risk non-ST-elevation acute coronary syndromes enrolled in the multinational GRACE…
Comparison
Delayed angiography (>72 hours from admission) vs Early angiography or no in-hospital angiography
Design
Cohort
Follow-up
6 months
Authors
Discussion
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Implication
May warrant prompt angiography in high-risk NSTE-ACS; leaves open causality versus confounding in observational data.
Study Design
Type
Cohort (n=23,396)
Multicenter
Yes
Structured PICO
Does delayed angiography (>72 hours) worsen clinical outcomes in patients with high-risk NSTE-ACS compared to early or no angiography?
P
Population
23,396 patients with high-risk non-ST-elevation acute coronary syndromes from a 14-country multinational registry, evaluated for in-hospital and 6-month outcomes.
E
Exposure
Delayed angiography (>72 hours from admission)
C
Comparator
Early angiography (≤72 hours) or no in-hospital angiography (conservative management)
O
Outcome
Composite major adverse cardiovascular event (MACE) comprising death, cerebrovascular accident, and myocardial infarction at 6 monthscomposite
Main Result
Absolute Event Rate: 18.9% vs 22.2%
p-value: p=0.015
In patients with high-risk NSTE-ACS, delaying angiography beyond 72 hours is associated with worse 6-month outcomes compared to earlier intervention, though it remains superior to a purely conservative strategy.
Cite This Study
Swanson et al. (2008) conducted a cohort in High-risk non-ST-elevation acute coronary syndromes (NSTE-ACS) (n=23,396). Delayed angiography (>72 hours from admission) vs. No angiography was evaluated on Composite major adverse cardiovascular event (MACE) comprising death, cerebrovascular accident and myocardial infarction (p=0.015). In patients with high-risk NSTE-ACS, delayed angiography (>72 hours) was associated with a lower rate of MACE compared to no angiography (18.9% vs 22.2%, p=0.015).