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Early Invasive Strategy Based on the Time of Symptom Onset of Non-ST-Segment Elevation Myocardial Infarction

Authors
 SungA Bae  ;  Jung-Joon Cha  ;  Subin Lim  ;  Ju Hyeon Kim  ;  Hyung Joon Joo  ;  Jae Hyoung Park  ;  Soon Jun Hong  ;  Cheol Woong Yu  ;  Do-Sun Lim  ;  Yongcheol Kim  ;  Woong Chol Kang  ;  Eun Jeong Cho  ;  Sang Yeub Lee  ;  Sang Wook Kim  ;  Eun-Seok Shin  ;  Seung Ho Hur  ;  Seok Kyu Oh  ;  Seong-Hoon Lim  ;  Hyo-Soo Kim  ;  Young Joon Hong  ;  Youngkeun Ahn  ;  Myung Ho Jeong  ;  Tae Hoon Ahn 
Citation
 JACC-CARDIOVASCULAR INTERVENTIONS, Vol.16(1) : 64-75, 2023-01 
Journal Title
JACC-CARDIOVASCULAR INTERVENTIONS
ISSN
 1936-8798 
Issue Date
2023-01
MeSH
Acute Coronary Syndrome* / etiology ; Coronary Angiography / methods ; Humans ; Myocardial Infarction* / etiology ; Non-ST Elevated Myocardial Infarction* / diagnostic imaging ; Non-ST Elevated Myocardial Infarction* / therapy ; Percutaneous Coronary Intervention* / adverse effects ; Percutaneous Coronary Intervention* / methods ; ST Elevation Myocardial Infarction* / diagnostic imaging ; ST Elevation Myocardial Infarction* / etiology ; ST Elevation Myocardial Infarction* / therapy ; Time Factors ; Treatment Outcome
Keywords
all-cause mortality ; invasive coronary angiography ; myocardial infarction ; symptom onset
Abstract
Background: A limitation of the current guidelines regarding the timing of invasive coronary angiography for patients with non-ST-segment elevation acute coronary syndrome is the randomization time. To date, no study has reported the clinical outcomes of invasive strategy timing on the basis of the time of symptom onset.

Objectives: The aim of this study was to investigate the effect of invasive strategy timing from the time of symptom onset on the 3-year clinical outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI).

Methods: Among 13,104 patients from the Korea Acute Myocardial Infarction Registry-National Institutes of Health, 5,856 patients with NSTE myocardial infarction were evaluated. The patients were categorized according to symptom-to-catheter (StC) time (<48 or ≥48 hours). The primary outcome was 3-year all-cause mortality.

Results: Overall, 3,919 patients (66.9%) were classified into the StC time <48 hours group. This group had lower all-cause mortality than the group with StC time ≥48 hours (7.3% vs 13.4%; P < 0.001). The lower risk for all-cause mortality in the group with StC time <48 hours group was consistent in all subgroups. Notably, emergency medical service use (HR: 0.31; 95% CI: 0.19-0.52) showed a lower risk for all-cause mortality than no emergency medical service use (HR: 0.54; 95% CI: 0.46-0.65; P value for interaction = 0.008).

Conclusions: An early invasive strategy on the basis of StC time was associated with a decreased risk for all-cause mortality in patients with NSTEMI. Because the study was based on a prospective registry, the results should be considered hypothesis generating, highlighting the need for further research. (iCReaT Study No. C110016).
Full Text
https://www.sciencedirect.com/science/article/pii/S1936879822018556
DOI
10.1016/j.jcin.2022.09.039
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yongcheol(김용철) ORCID logo https://orcid.org/0000-0001-5568-4161
Bae, SungA(배성아) ORCID logo https://orcid.org/0000-0003-1484-4645
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/193525
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