Key result
Early angiography within 12 hours reduces in-hospital mortality and recurrent MI in high-risk NSTEMI.
Why the study?
While guidelines recommend a routine invasive strategy in high-risk NSTE-ACS, this study sought to compare the outcomes of early versus late intervention in patients with high-risk NSTEMI.
RCT (n=60)
Random selection into two equal groups (n=30 each)
No
Answers are grounded in this paper and cite their sources.
May support early angiography in high-risk NSTEMI; hypothesis-generating and requires randomized confirmation.
IntroductionWith improvements in percutaneous coronary intervention and the advent of novel adjunctive pharmacotherapy agents (such as GP 2b/3a inhibitors, new antiplatelet agents, and intensive statin regimens), the safety and efficacy of early Percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) has improved significantly (1). Therefore, the current guidelines recommend a routine invasive strategy (angiography and revascularization if applicable) (2) in high-risk patients with non-'ST'-elevation ACS (NSTE-ACS).AimThe aim was to compare the results of early versus late intervention in patients with high-risk NSTE myocardial infarction (MI).Patients and methodsThis study was carried out on 60 patients who presented to the Emergency Department in the National Heart Institute with high-risk NSTEMI with GRACE score greater than 140 during the time period from December 2020 to July 2021. The patients fulfilled the following criteria: they had typical chest pain; they had ECG changes in the form of 'ST'-segment depression, 'T'-wave inversion, or even with normal ECG; they had elevated cardiac biomarkers; their estimated GRACE score was greater than 140. The eligible patients were divided into two groups: (there were no specific selection criteria for early or late intervention, but the selection was done randomly). Group A: included 30 patients with early treatment strategy as the angiography was performed as early as possible and within 12 h from the ischemic pain. Group B: included 30 patients with delayed treatment strategy as the angiography was performed after 48 h of intensive medical treatment.ConclusionBased on individual and careful patient and lesion assessments, early intervention in high-risk non-STEMI patients reduced the risk of in-hospital mortality and minor bleeding and consequently the time of hospital stay. It also decreased the occurrence of refractory angina, recurrent MI, and hospitalization for cardiac cause. It also helped to improve the ejection fraction.
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Aziz et al. (2022) conducted an RCT in High-risk non-ST-elevation myocardial infarction (NSTEMI) (n=60). Early invasive strategy (angiography within 12 hours of ischemic pain) vs. Delayed invasive strategy (angiography after 48 hours of intensive medical treatment) was evaluated on In-hospital mortality, minor bleeding, hospital length of stay, refractory angina, recurrent MI, cardiac hospitalization, and ejection fraction. Early angiography within 12 h in 60 high-risk NSTEMI patients (GRACE >140) reduced in-hospital mortality, minor bleeding, and recurrent MI compared to delayed intervention (>48 h).
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