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    Relation of Timing of Percutaneous Coronary Intervention on Outcomes in Patients With Non-ST Segment Elevation Myocardial Infarction

    Access Status
    Fulltext not available
    Authors
    Batchelor, R.J.
    Dinh, D.
    Brennan, A.
    Wong, N.
    Lefkovits, J.
    Reid, Christopher
    Duffy, S.J.
    Chan, W.
    Cox, N.
    Liew, D.
    Stub, D.
    Date
    2020
    Type
    Journal Article
    
    Metadata
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    Citation
    Batchelor, R.J. and Dinh, D. and Brennan, A. and Wong, N. and Lefkovits, J. and Reid, C. and Duffy, S.J. et al. 2020. Relation of Timing of Percutaneous Coronary Intervention on Outcomes in Patients With Non-ST Segment Elevation Myocardial Infarction. American Journal of Cardiology. 136: pp. 15-23.
    Source Title
    American Journal of Cardiology
    DOI
    10.1016/j.amjcard.2020.09.011
    ISSN
    0002-9149
    Faculty
    Faculty of Health Sciences
    School
    Curtin School of Population Health
    Funding and Sponsorship
    http://purl.org/au-research/grants/nhmrc/1111170
    http://purl.org/au-research/grants/nhmrc/1136372
    URI
    http://hdl.handle.net/20.500.11937/93758
    Collection
    • Curtin Research Publications
    Abstract

    International guidelines suggest revascularization within 24 hours in non-ST segment elevation myocardial infarction (NSTEMI). Within a large population cohort study, we aimed to explore clinical practice regarding timing targets for percutaneous coronary intervention (PCI) in NSTEMI. The Victorian Cardiac Outcomes Registry was established in 2013 as a state-wide clinical quality registry, pooling data from public and private PCI capable centers. Data were collected on 11,852 PCIs performed for NSTEMI from 2014 to 2018. Patients were divided into 3 groups by time of symptom onset to PCI (<24 hours; 24 to 72 hours; >72 hours). We performed multivariable logistic regression analysis conditional on several baseline covariates in investigating the impact of timing of PCI in NSTEMI on clinical outcomes. Patients who underwent PCI within 24 hours represented 18.4% (n = 2,178); 24 to 72 hours 45.8% (n = 5,434); >72 hours 35.8% (n = 4,240). Patients waiting longer for PCI were older (62.6 ± 12.2 vs 64.8 ± 12.6 vs 67.0 ± 12.7, p <0.001), more likely to be female (23.1% vs 24.2% vs 26.4%, p = 0.007), and have diabetes (18.6% vs 21.1% vs 27.1%, p <0.001). Multivariate logistic regression found that as compared with PCI <24 hours, PCI 24 to 72 hours and PCI >72 hours of symptom onset were associated with a decreased risk of 30-day mortality (odds ratio 0.55; 95% confidence interval 0.35 to 0.86, p = 0.008 and odds ratio 0.64; 95% confidence interval 0.35 to 1.01, p = 0.053, respectively). There was no significant difference in 30-day mortality between groups following exclusion of patients presenting with cardiogenic shock or out of hospital cardiac arrest requiring intubation. In conclusion, many registry patients undergo PCI outside the 24-hour window following NSTEMI. This delay is at odds with current guideline recommendations but does not appear to be associated with an increased mortality risk.

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