Delayed Intervention Ups Mortality in Coronary Syndrome

Mortality twice as high when PCI is delayed more than 24 hours compared to less than eight hours
By Jeff Muise
HealthDay Reporter

WEDNESDAY, March 31 (HealthDay News) -- Patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) who undergo percutaneous coronary intervention (PCI) within eight hours of clinical presentation have better mortality and cardiac outcomes than those in whom the procedure is delayed, according to a study in the April 6 issue of the Journal of the American College of Cardiology.

Paul Sorajja, M.D., of the Mayo Clinic in Rochester, Minn., and colleagues studied 7,749 patients who underwent PCI after experiencing NSTE-ACS. The researchers compared outcomes by length of delay from presentation to PCI: less than eight hours, eight to 24 hours, and more than 24 hours. Outcomes evaluated were 30-day mortality, myocardial infarction (MI), and a composite ischemia outcome that included death, MI, and unplanned revascularization.

The researchers found that mortality, MI, and the composite outcome rates were lower among patients in whom PCI was performed within eight hours of presentation compared to more than 24 hours: for mortality, 0.8 and 1.7 percent, respectively; for MI, 4.9 and 8.0 percent, respectively; and for composite ischemia, 7.9 and 10.4 percent, respectively. Those at greatest mortality risk from more than a 24-hour delay were found to be patients with high-risk features.

"In this large-scale study, delaying revascularization with PCI greater than 24 hours in patients with NSTE-ACS was an independent predictor of early and late mortality and adverse ischemic outcomes. These findings suggest that urgent angiography and triage to revascularization should be a priority in NSTE-ACS patients," the authors write.

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