Key result
Early PCI within 24 hours cuts major events ~72% versus delayed intervention.
Why the study?
The influence of the timing of invasive PCI on mortality, recurrent MI, re-hospitalization, and left ventricular function in moderate-high risk NSTEMI patients was unclear.
Does an early invasive strategy (PCI <24 hours) reduce mortality, recurrent MI, and re-hospitalization compared to a delayed invasive strategy (PCI 24-72 hours) in patients with moderate-high risk NSTEMI?
RCT (n=131)
Open-label
Computer-generated randomization
No
Does an early invasive strategy (PCI <24 hours) reduce mortality, recurrent MI, and re-hospitalization compared to a delayed invasive strategy (PCI 24-72 hours) in patients with moderate-high risk NSTEMI?
Absolute Event Rate: 8.7% vs 30.6%
p-value: p=0.001
An early invasive strategy (<24 hours) in moderate-high risk NSTEMI patients significantly reduces recurrent MI and cardiac re-hospitalization while preserving left ventricular function at 3 months compared to a delayed strategy.
Early invasive PCI timing in moderate-high risk NSTEMI may affect short-term outcomes; leaves open optimal strategy pending larger randomized trials.
BACKGROUND AND OBJECTIVES: We have intended to investigate the influence of the timing of invasive procedures on all-cause mortality, recurrent myocardial infarction (MI), re-hospitalization due to cardiac causes and left ventricular function over a 3-month period among patients with Non-ST-elevation myocardial infarction (NSTEMI). SUBJECTS AND METHODS: A total of 131 NSTEMI patients with moderate-high Thrombolysis in Myocardial Infarction risk scores, who had been admitted to our department between July 2011-December 2011 were included in our study. They had been randomized into 2 groups according to the timing of the percutaneous coronary intervention (PCI). Patient undergoing PCI in the first 24 hours of hospitalization were named the "Early Invasive Group" and those undergoing PCI between 24-72 hours of hospitalization were named the "Delayed Invasive Group". All patients were followed up for 3 months. RESULTS: Third month left ventricular ejection fraction (LVEF) values were higher in the early invasive group (59.9±6.0% vs. 54.1±8.7%; p<0.001). Recurrent MI rates were lower in the early invasive group (2.9% vs. 14.5%; p=0.016). Similarly, hospitalization rates due to cardiac events were lower in the early invasive group (8.7% vs. 30.6%; p=0.001). All cause mortality appeared to be lower in the early invasive group, although not to a statistically significant degree (0% vs. 4.8%; p=0.065). CONCLUSION: The early invasive strategy appears to be more effective for the reduction of recurrent MI, re-hospitalization due to cardiac events, and the preservation of 3rd month LVEF in patients with moderate-high risk NSTEMI when compared to a delayed invasive strategy.
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Tekin et al. (2013) conducted an RCT in Non-ST-elevation myocardial infarction (NSTEMI) (n=131). Early percutaneous coronary intervention (within 24 hours) vs. Delayed percutaneous coronary intervention (24-72 hours) was evaluated on Compound endpoint (recurrent MI, cardiac-related hospitalization, and all-cause death) (p=0.001). Early percutaneous coronary intervention within 24 hours significantly reduced the compound endpoint of recurrent MI, cardiac hospitalization, and all-cause death compared to delayed intervention (8.7% vs 30.6%, p=0.001).
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