Timing of Angiography and Outcomes in High-Risk Patients With Non–ST-Segment–Elevation Myocardial Infarction Managed Invasively
Key result
Angiography within 12 hours linked to ~29% lower death and MI risk vs. delayed angiography.
- OR 0.71
- 95% CI 0.55-0.91
- n=4,071
Why the study?
Does very early coronary angiography (<12 hours) reduce the risk of death and myocardial infarction in high-risk NSTEMI patients compared to later angiography?
Population
4,071 patients with non-ST-segment-elevation myocardial infarction (NSTEMI) and GRACE score >140
Comparison
Very early coronary angiography performed <12… vs Early or delayed coronary angiography
Design
Cohort
Follow-up
180 days
Authors
Discussion
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Implication
May support <12-hour angiography in high-risk NSTEMI; hypothesis-generating and requires RCT confirmation before practice change.
Study Design
Type
Cohort (n=4,071)
Structured PICO
Does very early coronary angiography (<12 hours) reduce the risk of death and myocardial infarction in high-risk NSTEMI patients compared to later angiography?
P
Population
4,071 patients with high-risk NSTEMI (GRACE score >140) undergoing coronary angiography, followed for 180 days.
E
Exposure
Very early coronary angiography (CAG) performed <12 hours from admission
C
Comparator
Early (12-24 hours) or delayed (≥24 hours) coronary angiography
O
Outcome
Composite of all-cause death and myocardial infarction within 180 days of randomizationcomposite
Main Result
Odds Ratio: 0.71 (95% CI 0.55–0.91)
In high-risk NSTEMI patients, performing coronary angiography within 12 hours of admission is associated with a lower risk of death and myocardial infarction at 180 days compared to later angiography.
Limitations
- Post hoc analysis
Cite This Study
Deharo et al. (2017) conducted a cohort in Non-ST-Segment-Elevation Myocardial Infarction (NSTEMI) with GRACE score >140 (n=4,071). Coronary angiography <12 hours from admission vs. Coronary angiography ≥24 hours from admission was evaluated on Composite of all-cause death and myocardial infarction within 180 days (OR 0.71, 95% CI 0.55-0.91). Coronary angiography within 12 hours of admission was associated with a lower risk of death and myocardial infarction at 180 days compared to angiography at ≥24 hours (OR 0.71; 95% CI 0.55-0.91).