Objectives
We aimed to explore the impact of time to percutaneous coronary intervention (PCI) (T2P) on 1‐year mortality in non‐ST‐elevation myocardial infarction (NSTEMI) patients.
Background
The current guidelines recommend an early invasive strategy for NSTEMI patients. However, impact of an early invasive strategy on mortality is a matter of debate. For that reason, real world data are of great value to determine the optimal treatment window.
Methods
This retrospective single center cohort study was performed in a high‐volume PCI center in Amsterdam, The Netherlands. Intermediate‐ and high‐risk NSTEMI patients undergoing PCI were included. The main discriminant was timing of PCI after admission (T2P), stratified according to different time windows (<24 h, 24–72 h, 72 h–7 days or >7 days). We analyzed 1‐year mortality and the time distribution of overall survival.
Results
In total, 848 patients treated between January 1, 2016 and January 1, 2018 were included in the analysis. T2P was <24 h in 145 patients, 24–72 h in 192 patients, 72 h–7 days in 275 patients, and >7 days in 236 patients. The mean GRACE‐risk score was 127.1 (SD 28.7), 130.0 (33.1), 133.8 (32.1), and 148.7 (34.6) respectively, p = <0.001. After adjusting for confounders, 1‐year mortality in patients with T2P <24 h did not significantly differ when compared with T2P 24–72 h (OR = 1.08; 95% CI = 0.33–3.51) and T2P 72 h–7 days (OR 1.72; 95% CI = 0.57–5.21) but was significantly higher in T2P >7 days (OR = 3.20; 95% CI = 1.06–9.68).
Conclusions
In an unselected cohort of patients with NSTEMI, treatment by PCI <24 h did not lead to improved survival as compared to aT2P <7 days strategy. Delay in PCI >7 days after admission resulted in worse outcome.