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 NSTE-ACS and its prognostic impact on in-hospital mortality. It is about a single-center observational study that included 507 patients admitted for acute coronary syndrome without ST-segment elevation from January 2011 until December 2015. The average age of our patients was 62.85 ± 11.37 years. Nearly half of our patients (49.5%) were considered at high cardiovascular risk. The average to coronary angiography was 4.09 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 = 0.0009). 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. All cases of death were observed in the medically treated or the delayed coronary angiography group (0% vs. 2.9%, P = 0.01). 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 NSTE-ACS patients, the use of this strategy remains insufficient.