Early Invasive Strategy Based on the Time of Symptom Onset of Non-ST-Segment Elevation Myocardial Infarction
SungA Bae1, Jung-Joon Cha2, Subin Lim2
1Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea; Department of Cardiology, Yongin Severance Hospital, Yonsei University College of Medicine, Gyeonggi-do, Republic of Korea.
Insights
An early invasive strategy for non-ST-segment elevation myocardial infarction (NSTEMI) patients, based on symptom-to-catheter time, significantly reduces 3-year all-cause mortality. Emergency medical service use further lowers mortality risk in these patients.
Area of Science:
- Cardiology
- Clinical Research
- Public Health
Background:
- Current guidelines for acute coronary syndrome lack clarity on optimal invasive angiography timing based on symptom onset.
- Previous studies have not evaluated clinical outcomes related to invasive strategy timing relative to symptom onset.
Purpose of the Study:
- To investigate the impact of invasive strategy timing, specifically symptom-to-catheter (StC) time, on 3-year clinical outcomes in patients with non-ST-segment elevation myocardial infarction (NSTEMI).
Main Methods:
- A cohort of 5,856 NSTEMI patients from the Korea Acute Myocardial Infarction Registry-National Institutes of Health was analyzed.
- Patients were stratified into two groups based on StC time: <48 hours and ≥48 hours.
- The primary endpoint was 3-year all-cause mortality.
Main Results:
- Patients with an StC time <48 hours exhibited significantly lower 3-year all-cause mortality (7.3%) compared to those with StC time ≥48 hours (13.4%; P < 0.001).
- This reduced mortality risk with early intervention (<48 hours) was consistent across all patient subgroups.
- Emergency medical service utilization was associated with a significantly lower risk of all-cause mortality (HR: 0.31) compared to non-utilization (HR: 0.54).
Conclusions:
- An early invasive strategy, determined by StC time, is associated with reduced 3-year all-cause mortality in NSTEMI patients.
- The findings suggest that prompt cardiac catheterization may improve long-term outcomes for NSTEMI patients.
- Further research is warranted to confirm these hypothesis-generating results from the prospective registry study.
Background:
A limitation of the current guidelines regarding the timing of invasive coronary angiography for patients with non-ST-segment elevation acute coronary syndrome is the randomization time. To date, no study has reported the clinical outcomes of invasive strategy timing on the basis of the time of symptom onset.
Objectives:
The aim of this study was to investigate the effect of invasive strategy timing from the time of symptom onset on the 3-year clinical outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI).
Methods:
Among 13,104 patients from the Korea Acute Myocardial Infarction Registry-National Institutes of Health, 5,856 patients with NSTE myocardial infarction were evaluated. The patients were categorized according to symptom-to-catheter (StC) time (<48 or ≥48 hours). The primary outcome was 3-year all-cause mortality.
Results:
Overall, 3,919 patients (66.9%) were classified into the StC time <48 hours group. This group had lower all-cause mortality than the group with StC time ≥48 hours (7.3% vs 13.4%; P < 0.001). The lower risk for all-cause mortality in the group with StC time <48 hours group was consistent in all subgroups. Notably, emergency medical service use (HR: 0.31; 95% CI: 0.19-0.52) showed a lower risk for all-cause mortality than no emergency medical service use (HR: 0.54; 95% CI: 0.46-0.65; P value for interaction = 0.008).
Conclusions:
An early invasive strategy on the basis of StC time was associated with a decreased risk for all-cause mortality in patients with NSTEMI. Because the study was based on a prospective registry, the results should be considered hypothesis generating, highlighting the need for further research. (iCReaT Study No. C110016).
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