Key result
Early PCI linked to ~4.6-fold higher mortality vs. delayed PCI in concomitant sepsis and NSTEMI.
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Why the study?
The optimal timing of PCI in patients with sepsis and concomitant non-ST elevation myocardial infarction remains controversial and lacks specific guideline recommendations.
Does early PCI compared to delayed PCI reduce mortality and adverse outcomes in hospitalized patients with concomitant sepsis and NSTEMI?
Cohort (n=217)
Yes
Does early PCI compared to delayed PCI reduce mortality and adverse outcomes in hospitalized patients with concomitant sepsis and NSTEMI?
In patients hospitalized with sepsis and concomitant NSTEMI, delaying PCI for ≥72 hours is associated with significantly lower in-hospital all-cause mortality compared to early intervention.
BACKGROUND The prognosis of patients with concomitant sepsis and severe coronary artery disease (CAD) who develop acute myocardial infarction (AMI) is poor. While percutaneous coronary intervention (PCI) can improve survival in AMI during and post sepsis, the decision is complex due to high mortality rates and increased risk of complications. The optimal timing of intervention for these patients, once clinically indicated, remains controversial, with specific recommendations for revascularization lacking in current guidelines. This retrospective analysis investigates and compares clinical outcomes of early PCI strategy (<72 h from diagnosis of MI) versus delayed PCI strategy (≥72 h) in patients who were hospitalized with sepsis and concomitantly developed AMI. METHODS This multicenter retrospective study included 217 hospitalized patients with sepsis and AMI who underwent PCI after sepsis treatment, from January 2016 to May 2024. Patients with ST-elevation myocardial infarctions and non-obstructive CAD were excluded. Of these, 75 patients received early PCI, and 142 underwent delayed PCI. We analyzed in-hospital all-cause mortality, major cardiovascular events, progression to shock, length of stay, and readmission rates at 45 days and 1 year. RESULTS The mean peak serum troponin I level in the early revascularization cohort was higher (13.1 ng/mL vs. 7.8 ng/mL; P < 0.01). Baseline characteristics were otherwise similar. There was significantly higher all-cause mortality (16% vs. 3.5%; P < 0.01) associated with early PCI in patients with concomitant sepsis. However, a delayed invasive strategy was associated with a 28% longer length of stay (14.6 days vs. 11.4 days) and a greater likelihood of progression to shock (RR 1.41). There were no major differences in 45-day and 1-year readmission rates between the cohorts. CONCLUSIONS In patients with non-ST elevation myocardial infarction in the context of sepsis, early PCI was associated with higher all-cause mortality compared to delayed PCI. The delayed PCI cohort had longer lengths of stay; however, these findings may be attributable to the lower mortality in this group. This study suggests that in select patients with concomitant MI and sepsis, it may not be unreasonable to prioritize treating the sepsis prior to attempting revascularization. However, major limitations exist in the study and a randomized controlled trial is warranted to further investigate these findings.
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Golzarian et al. (2026) conducted a cohort in sepsis and non-ST elevation myocardial infarction (n=217). Early percutaneous coronary intervention (<72 hours) vs. Delayed percutaneous coronary intervention (≥72 hours) was evaluated on in-hospital all-cause mortality (p=<0.01). Early PCI (<72 hours) in patients with concomitant sepsis and NSTEMI was associated with significantly higher all-cause mortality compared to delayed PCI (16% vs. 3.5%; P<0.01).
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