CCCardiol CroatCardiologia CroaticaCardiol. Croat.1848-543X1848-5448Croatian Cardiac SocietyCC_13(11-12)_31110.15836/ccar2018.311Extended AbstractThe outcomes in patients with acute non-ST elevation myocardial infarction treated with percutaneous coronary intervention within 24h after onset, delayed percutaneous coronary intervention or optimal medical therapy at initial hospitalization and during one-year follow-up: the experience from the Croatian branch of the ISACS-CT RegistryUnutarbolnički i ishodi nakon jedne godine praćenja u bolesnika s akutnim infarktom miokarda bez elevacije ST-segmenta liječenih perkutanom koronarnom intervencijom unutar 24 sata, odgođenom perkutanom koronarnom intervencijom ili optimalnom medikamentnom terapijom: iskustva iz Hrvatskog ogranka registra ISACS-CTDorja Sabljak* (https://orcid.org/0000-0002-7785-5555), Filip Lončarić (https://orcid.org/0000-0002-7865-110), Petra Mjehović (https://orcid.org/0000-0003-4908-4674), Antonija Mišković (https://orcid.org/0000-0002-8483-3856), Dominik Oroz (https://orcid.org/0000-0002-9837-7214), Ines Vinković (https://orcid.org/0000-0003-1705-8295), Vedrana Vlahović (https://orcid.org/0000-0002-8021-4855), Grgur Salai (https://orcid.org/0000-0002-7782-1646), Saša Pavasović (https://orcid.org/0000-0002-3705-0226), Nina Jakuš (https://orcid.org/0000-0002-9346-6402), Dora Fabijanović (https://orcid.org/0000-0003-2633-3439), Maja Čikeš (https://orcid.org/0000-0002-4772-5549), Davor Miličić (https://orcid.org/0000-0001-9101-1570)Medicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb, Zagreb, HrvatskaUniversity of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, CroatiaADDRESS FOR CORRESPONDENCE: Dorja Sabljak, Klinički bolnički centar Zagreb, Kišpatićeva 12, HR-10000 Zagreb, Croatia. / Phone: +385-99-3776-877 / E-mail: dorja.sabljak169@gmail.com1120181311-1231131228102018051120182018Croatian Cardiac SocietyKLJUČNE RIJEČI: akutni koronarni sindromperkutana koronarna intervencijaKEYWORDS: acute coronary syndromepercutaneous coronary intervention
Background and aim: Previous studies found conflicting results on the effects of earlier invasive intervention in a heterogeneous population of acute non-ST elevation myocardial infarction (NSTEMI) (1). Our aim was to explore in-hospital and 1-year follow-up outcomes in NSTEMI patients (pts) treated with PCI in the first 24 h, PCI after 24 h and optimal medical therapy (OMT).
Patients and Methods: From January 2012 to October 2017, 1898 pts were enrolled in the Croatian arm of the ISACS-CT registry (NCT01218776) 36% (n=685) with NSTEMI, of which 675 had available data on treatment modality. One-year follow-up was available in 217 (32%) of the NSTEMI patients.
Results: In 57% (n=386) of pts PCI was done within 24 h from symptoms onset, in 14% (n=95) after 24 h, while 29% (n=194) were discharged with OMT. Pts in the OMT group were significantly older, with more comorbidities, with a lower left ventricular ejection fraction (LVEF) value at discharge and greater delay from symptom onset to hospitalization (Table 1). Pts with PCI performed within 24 h had the greatest frequency of PCI reintervention during follow-up (PCI ≤ 24 h; PCI > 24 h; OMT: 15%; 3%; 0%; p=0.008). In-hospital mortality did not significantly differ between the groups (PCI ≤ 24 h; PCI > 24 h; OMT: 2.5%; 3.5%; 4.6%; p=0.220), yet in those with data on 1-year mortality (Figure 1), this was the highest in the OMT group (PCI ≤ 24 h; PCI > 24 h; OMT: 3.3%; 8.3%; 19.4%; p=0.005). Univariable regression suggested that PCI < 24 h significantly reduced mortality at 1-year follow-up (OR 0.14, 95% CI 0.04-0.51, p=0.03). The effect was lost after adjustment for age, LVEF and chronic kidney disease (CKD) in a multivariable model, which proved LVEF (OR 0.95, 95% CI 0.90-0.99, p=0.049) and CKD (OR 6.31, 95% CI 1.67-23.8, p=0.007) as the only significant predictors of survival.
Patient demographic data.
PCI in first 24 h (n=386)
PCI after 24h (n=95)
OMT (n=194)
P value
Male gender, n (%)
287 (73)
55 (58)
108 (55)
<0.001
Age, mean, (SD), years
64 (11)
68 (11)
73 (11.4)
<0.001
BMI, median, (P25, P75) kg/m2
28.7 (26.1, 31.9)
28.6 (25.6, 32.6)
27.7 (25.1, 31.1)
0.183
Beta-blockers before initial admission, n (%)
150 (39)
37 (40)
90 (52)
0.013
Diuretics before initial admission, n (%)
116 (30)
42 (45)
94 (49)
<0.0001
Statins before initial admission, n (%)
112 (29)
37 (40)
72 (41)
0.008
Chronic kidney disease, n (%)
48 (14)
20 (23)
37 (25)
0.005
Diabetes mellitus, n (%)
122 (31)
38 (40)
70 (36)
0.177
Hypercholesterolemia n (%)
246 (64)
58 (63)
95 (55)
0.153
Hypertension, n (%)
320 (82)
77 (81)
162 (85)
0.590
Onset of symptoms to admission <6h, n (%)
185 (48)
42 (45)
112 (61)
0.005
Creatinine, median, (P25, P75) µmol/L
94 (80, 109)
90 (77, 114)
103 (85, 128)
<0.001
Discharge LVEF mean, (SD), %
53 (12)
51 (13)
49 (14)
0.002
Discharge EF <40%, n (%)
65(17)
20(21)
53 (27)
0.010
Hospitalization, median, (P25, P75), days
5 (4,8)
5 (4, 9)
8 (6,11)
<0.001
PCI – percutaneous coronary intervention, OMT – optimal medical therapy, BMI – body mass index, EF – left ventricular ejection fraction, SD – standard deviation,P – percentile, h – hours.
Conclusion: NSTEMI patients in the three treatment groups had different risk profiles at hospitalization, the OMT group being burdened with most comorbidities. The therapy of choice did not seem to have a significant influence on in-hospital or 1-year survival. Due to their higher risk profile, the pts treated with OMT had significantly lower 1-year survival, with lower LVEF and higher rate of CKD as predictors of primary outcome.
LITERATUREMilosevicAVasiljevic-PokrajcicZMilasinovicDMarinkovicJVukcevicVStefanovicBImmediate Versus Delayed Invasive Intervention for Non-STEMI Patients: The RIDDLE-NSTEMI Study.JACC Cardiovasc Interv. 2016 Mar 28;9(6):541–9. 10.1016/j.jcin.2015.11.01826777321