High-Risk Acute Coronary Syndrome Patients Benefit From Early Intervention Within 24 Hours
National Heart Centre Singapore, Singapore, Singapore
J.K. Tan, H.W. Chong, H.H. Shim, A.S. Koh, K.W. Guo, L.W. Khin, S. Chia, A.S. Wong, S.T. Lim, T.S. Chua, T.H. Koh, J.W. Tan
Background: Recent studies have demonstrated the benefits of an early invasive strategy for patients presenting with high-risk acute coronary syndrome (ACS). However, it is unclear whether there is incremental benefit if cardiac catheterization (CATH) is performed within 24 hours. The aim of this study is to determine if patients with high-risk ACS who undergo early (£24h) compared to routine (>24h) intervention have improved clinical outcome.
Methods: Prospective data from consecutive patients with ACS undergoing CATH were collected from our centre between October 2008 and April 2009. We included baseline clinical characteristics, angiographic findings, revascularization methods and clinical outcomes. Primary endpoints were in-hospital complications and 30-day and 6-month composite major adverse cardiac events (MACE): death, re-myocardial infarction (MI) and need for repeat target vessel revascularization (TVR).
Results: We included 354 consecutive patients with an average time from admission to CATH of 48¡¾4 hours. 161 patients (45%) underwent CATH ¡Â24h. Among high-risk ACS patients with TIMI risk score ¡Ã4 (n=178), a significantly less proportion of patients underwent CATH ¡Â24h (38% vs 62%, p=0.006). Weekend admission accounted for 66% of patients (n=127) who had CATH >24h. Compared to high-risk ACS patients (TIMI risk score ¡Ã4) who underwent CATH >24h (n=110), high-risk ACS patients with early CATH £24h (n=68) had a trend toward a lower incidence of 30-day composite MACE (2.9% vs 9.1%, p=0.112), 30-day nonfatal MI (1.5% vs 5.5%, p=0.186), 30-day TVR (0% vs 2.8%, p=0.171) and 6-month nonfatal MI (3% vs 9.3%, p=0.116).
Conclusion: An early invasive strategy with CATH performed within 24 hours in high-risk ACS patients was associated with better clinical outcome in this observational study.
