Outcomes in non-ST-segment elevation myocardial infarction complicated by in-hospital cardiac arrest based on management strategy
Key result
Early coronary angiography, delayed angiography, and PCI in NSTEMI were associated with lower incidence of in-hospital cardiac arrest compared to medical management (early CAG aOR 0.67; P<0.001).
Why the study?
Data were limited on in-hospital cardiac arrest complicating NSTEMI according to management strategy.
Does early coronary angiography, delayed coronary angiography, or PCI reduce in-hospital mortality and incidence of IHCA compared to medical management in adults with NSTEMI?
Population
6,583,662 adult NSTEMI admissions not undergoing CABG
Comparison
Early CAG vs delayed CAG vs PCI vs medical management
Design
Retrospective database cohort study
Follow-up
In-hospital
Authors
Discussion
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Implication
Early invasive strategy was associated with lower IHCA and mortality in NSTEMI; leaves open whether randomized trials would confirm benefit.
Study Design
Type
Observational (n=6,583,662)
Multicenter
Yes
Structured PICO
Does early coronary angiography, delayed coronary angiography, or PCI reduce in-hospital mortality and incidence of IHCA compared to medical management in adults with NSTEMI?
P
Population
6,583,662 adult admissions with NSTEMI not undergoing CABG, evaluated for in-hospital cardiac arrest and mortality based on management strategy.
E
Exposure
Early coronary angiography (hospital day 0), delayed coronary angiography (≥hospital day 1), or percutaneous coronary intervention (PCI)
C
Comparator
Medical management
O
Outcome
Incidence of in-hospital cardiac arrest (IHCA) and in-hospital mortalityhard clinical
Main Result
Odds Ratio: 0.67 (95% CI 0.65–0.69)
Absolute Event Rate: 1.1% vs 1.4%
p-value: p=<0.001
Invasive strategies including early or delayed coronary angiography and PCI are associated with lower incidence of in-hospital cardiac arrest and lower in-hospital mortality compared to medical management in NSTEMI patients.
Cite This Study
Verghese et al. (2023) conducted an observational in Non-ST-segment elevation myocardial infarction (NSTEMI) (n=6,583,662). Early coronary angiography (CAG) vs. Medical management was evaluated on Incidence of in-hospital cardiac arrest (IHCA) (aOR 0.67, 95% CI 0.65-0.69, p=<0.001). Early coronary angiography, delayed angiography, and PCI in NSTEMI were associated with lower incidence of in-hospital cardiac arrest compared to medical management (early CAG aOR 0.67; P<0.001).