0409: Selection and timing for invasive therapy in non ST segment elevation acute coronary syndrome: Impact in the real world

Abstract

The optimal timing of coronary intervention in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter of debate. We proposed through this work to study the optimal time to coronary angiography in patients admitted for acute coronary syndrome without ST-segment elevation in the Tunisian context and its prognostic impact on inhospital mortality. It is about an observational study from MIRACOS registry that included 407 patients admitted for NSTE-ACS. We were interested to find general characteristics, the time to coronary angiography, mortality and in-hospital complications. A total of 407 patients were included in our study. Nearly half of our patients (49.5%) were considered at high cardiovascular risk. The average to coronary angiography was 5.09 days. Patients who underwent early coronary angiography were significantly younger (p=0.01), had a lower incidence of diabetes (p=0.01), left heart failure (p=0.0001) and electrical changes suggestive of ischemia (p=0.009). Patients who have undergone an invasive strategy had significantly lower levels of creatinine (p<0.0001) and significantly lower GRACE score (p=0.0001). The absence of renal failure, the absence of left ventricular failure, a low GRACE score and the absence of anemia were independent predictors of use of an invasive strategy. The overall mortality among patients included in the study was 2.9%. High heart rate (p=0.04), presence of heart failure (p=0.01), a high serum creatinine (p<0.001) and GRACE score (p<0.0001) were predictors of mortality in ACS ST (-) in our population. The group that underwent early coronary angiography had a statistically significant reduction in MACE (3.4% vs. 15.7%, p=0.04). Despite the fact that our work has showed that invasive strategy is associated with a better prognosis in ACS ST (-) patients, the use of this strategy remains insufficient.