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September 22, 2026Catheterization and Cardiovascular Interventions
Early Versus Delayed Percutaneous Coronary Intervention in Patients With NSTEMI and Stable Heart Failure
Key result
Early PCI linked to ~12% more major events vs delayed PCI in NSTEMI with stable HF.
- RR 1.12
- 95% CI 1.07-1.18
- P<0.01
- n=4,498
Why the study?
The optimal timing of PCI in patients with NSTEMI and stable heart failure remains unclear.
Does early PCI (< 24 h) reduce adverse cardiovascular outcomes in patients with NSTEMI and stable heart failure compared to delayed PCI (≥ 24 h)?
Key Points
- To evaluate and compare 1-month and 1-year cardiovascular outcomes associated with early (< 24 hours) versus delayed (≥ 24 hours) percutaneous coronary intervention in patients presenting with NSTEMI and stable heart failure.
- Analyzed adult patients with NSTEMI and stable heart failure using the TriNetX database, excluding those with decompensated heart failure, STEMI, or pregnancy.
- Balanced cohorts based on PCI timing (< 24 hours vs. ≥ 24 hours) via 1:1 propensity-score matching, resulting in 2,249 patients in each cohort (standardized mean difference < 0.1).
- Evaluated primary composite outcomes (all-cause mortality, heart failure exacerbation, recurrent myocardial infarction, and ventricular tachycardia/fibrillation) and secondary endpoints at 1 month and 1 year.
- Early PCI was associated with a higher risk of the primary composite outcome at 1 month (RR = 1.23, 95% CI: 1.15–1.31, p < 0.01) and at 1 year (RR = 1.12, 95% CI: 1.07–1.18, p < 0.01) compared with delayed PCI.
- Early PCI correlated with increased risks of recurrent myocardial infarction at both time points and higher heart failure exacerbation at 1 month, whereas all-cause mortality and ventricular tachycardia/fibrillation rates were comparable between groups.
Study Design
Type
Cohort (n=4,498)
Structured PICO
Does early PCI (< 24 h) reduce adverse cardiovascular outcomes in patients with NSTEMI and stable heart failure compared to delayed PCI (≥ 24 h)?
P
Population
4,498 adults with NSTEMI and stable heart failure, balanced via propensity-score matching, followed for up to 1 year to compare early versus delayed PCI.
E
Exposure
Early percutaneous coronary intervention (PCI) performed < 24 hours
C
Comparator
Delayed percutaneous coronary intervention (PCI) performed ≥ 24 hours
O
Outcome
Composite of all-cause mortality, HF exacerbation, recurrent myocardial infarction (MI), and ventricular tachycardia/fibrillation (VT/VF) assessed at 1 month and 1 yearcomposite
Main Result
Relative Risk: 1.12 (95% CI 1.07–1.18)
p-value: p=< 0.01
In patients with NSTEMI and stable heart failure, early PCI (< 24 hours) is associated with a higher risk of adverse cardiovascular outcomes compared to delayed PCI.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“There's time for pause. There is time for optimization of guideline-directed medical therapy for heart failure with reduced ejection fraction. And there is time for then bringing these patients back into your heart failure clinics or your outpatient cardiology clinics, determining their volume status, [and] determining lack of barriers to adherence to medical therapy for heart failure.”
Implication
Optimal PCI timing in NSTEMI with stable HF remains uncertain; leaves open whether early intervention improves outcomes in prospective trials.
Abstract
BACKGROUND: Early percutaneous coronary intervention (PCI) has been shown to improve outcomes in certain high-risk patients with non-ST-segment elevation myocardial infarction (NSTEMI), but its optimal timing in those with stable heart failure (HF) remains unclear. AIM: We aimed to compared 1 month and 1 year cardiovascular outcomes between early (< 24 h) and delayed (≥ 24 h) PCI in patients with NSTEMI with stable HF. METHODS: We identified adults with both NSTEMI and HF in TriNetX, then divided them based on PCI timing. We excluded patients with decompensated HF, STEMI, or pregnancy. Cohorts were then balanced using propensity-score matching, with standardized mean difference < 0.1. Our primary outcome was a composite of all-cause mortality, HF exacerbation, recurrent myocardial infarction (MI), and ventricular tachycardia/fibrillation (VT/VF). Secondary outcomes included individual primary outcome components, acute kidney injury, and major bleeding. Outcomes were assessed at 1 month and 1 year, expressed as relative risks (RR) with 95% confidence intervals (CI). RESULTS: After matching, we included 2249 patients in each cohort. After PSM, the mean age of the early PCI cohort was 69.3 ± 11.5 years, while that of the delayed PCI cohort was 69.2 ± 11.7 years, with 35% women. Hypertension (84.8%), hyperlipidemia (67.2%), and diabetes mellitus (53.1%) were the most prevalent comorbidities. Patients included both HF with preserved and reduced ejection fraction (HFpEF and HFrEF). Early PCI was associated with a higher risk of the primary outcome at both 1 month (RR = 1.23, 95% CI: 1.15-1.31, p < 0.01) and 1 year (RR = 1.12, 95% CI: 1.07-1.18, p < 0.01), compared with delayed PCI. Early PCI was associated with higher risk of recurrent MI at both time points, while risk of all-cause mortality and VT/VF were similar. Risk of HF exacerbation was higher with early PCI at 1 month but was comparable at 1 year. CONCLUSION: In patients with NSTEMI and stable HF, early PCI was associated with higher risk of adverse cardiovascular outcomes, warranting further investigation in this understudied subgroup.
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Cite This Study
Hanif et al. (2026) conducted a cohort in NSTEMI and stable heart failure (n=4,498). Early PCI (< 24 h) vs. Delayed PCI (≥ 24 h) was evaluated on Composite of all-cause mortality, HF exacerbation, recurrent myocardial infarction (MI), and ventricular tachycardia/fibrillation (VT/VF) (RR 1.12, 95% CI 1.07-1.18, p=< 0.01). Early PCI was associated with a higher risk of the primary composite outcome at 1 year compared with delayed PCI in patients with NSTEMI and stable heart failure (RR 1.12; 95% CI 1.07-1.18; p<0.01).