Stepwise relationship between delay in percutaneous coronary intervention and long-term mortality in patients with
Kamil Bujak1, Mariusz Gąsior2, Mateusz Tajstra2
13rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland. kamil_bujak@o2.pl.
Insights
For non-ST-segment elevation myocardial infarction (NSTEMI) patients, longer door-to-percutaneous coronary intervention (PCI) times are linked to increased long-term mortality. This study confirms a stepwise relationship between delayed PCI and higher death rates at 12 and 36 months.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Current guidelines advocate for timely coronary catheterization in non-ST-segment elevation myocardial infarction (NSTEMI) patients within 24 hours of admission.
- The relationship between the timing of percutaneous coronary intervention (PCI) and long-term mortality in NSTEMI patients undergoing early invasive treatment remains unclear.
Purpose of the Study:
- To investigate the association between door-to-PCI time and all-cause mortality at 12 and 36 months.
- To analyze outcomes in NSTEMI patients treated with PCI within 24 hours at a PCI-capable center.
Main Methods:
- Analysis of a nationwide registry of acute coronary syndromes (2007-2019) for NSTEMI patients.
- Stratification into 12 groups based on 2-hour door-to-PCI time intervals.
- Propensity score weighting with overlap weights to adjust for 33 confounding variables.
Main Results:
- A total of 37,589 NSTEMI patients were included.
- Increased 12-month and 36-month mortality rates were observed across consecutive door-to-PCI time intervals.
- A significant positive correlation was found between time to PCI and mortality (rs = 0.61 for 12 months, rs = 0.65 for 36 months).
Conclusions:
- Longer door-to-PCI times are associated with higher all-cause mortality rates at 12 and 36 months in NSTEMI patients.
- The findings support the importance of minimizing delays in PCI for NSTEMI patients to improve long-term survival.
Background:
Current guidelines recommend coronary catheterization in patients with non-ST- -segment elevation myocardial infarction (NSTEMI) within 24 hours of hospital admission. However, whether there is a stepwise relationship between the time to percutaneous coronary intervention (PCI) and long-term mortality in patients with NSTEMI treated invasively within 24 hours of admission has not been established yet.
Aims:
The study aimed to evaluate the association between door-to-PCI time and all-cause mortality at 12 and 36 months in NSTEMI patients presenting directly to a PCI-capable center who underwent PCI within the first 24 hours of hospitalization.
Methods:
We analyzed data of patients hospitalized for NSTEMI between 2007-2019, included in the nationwide registry of acute coronary syndromes. Patients were stratified into twelve groups based on 2-hour intervals of door-to-PCI time. The mortality rates of patients within those groups were adjusted for 33 confounding variables by the propensity score weighting method using overlap weights.
Results:
A total of 37 589 patients were included in the study. The median age of included patients was 66.7 (interquartile range [IQR], 59.0-75.8) years; 66.7% were male, and the median GRACE (Global Registry of Acute Coronary Events) score was 115 (98-133). There were increased 12-month and 36-month mortality rates in consecutive groups of patients stratified by 2-hour door-to-PCI time intervals. After adjustment for patient characteristics, there was a significant positive correlation between the time to PCI and the mortality rates (rs = 0.61; P = 0.04 and rs = 0.65; P = 0.02 for 12-month and 36-month mortality, respectively).
Conclusions:
The longer the door-to-PCI time, the higher were 12-month and 36-month all-cause mortality rates in NSTEMI patients.
More Related Videos
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
05:26Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:27Coronary Artery Disease V: Interprofessional Care
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...