MedStar Investigators Evaluate Importance of Revascularization Speed in NSTEMI Cardiology Patients

Recently published research evaluated whether and how the timing of percutaneous coronary intervention (PCI) affects the 1-year rate of major adverse cardiac events (MACE) in patients presenting with non-ST-elevation myocardial infarction (NSTEMI).  The study sought to describe outcomes in patients presenting with NSTEMI and analyze the data in an effort to assess the outcome of rapid revascularization in patients presenting with NSTEMI.

“Should Non-ST-Elevation Myocardial Infarction be Treated like ST-Elevation Myocardial Infarction With Shorter Door-to-Balloon Time?” was published in The American Journal in Cardiology. The collaborative research team included Micaela Iantorno MD, MHS; Evan Shlofmitz DO; Rebecca Torguson MPH; Paul Kolm PhD; Deepakraj Gajanana MD; Nauman Khalid MD; Yuefeng Chen MD, PhD; William S. Weintraub MD; and Ron Waksman MD from MedStar Washington Hospital Center, Section of Interventional Cardiology; and Toby Rogers MD, PhD from the MedStar Washington Hospital Center and the National Heart, Lung and Blood Institute, National Institutes of Health.

In the United States, it is estimated that more than 780,000 persons will experience an acute coronary syndrome and nearly 70% of these will have non-ST-elevation myocardial infarction. The research team identified 1550 patients who underwent PCI for NSTEMI and collected clinical and follow-up data. The patients were divided into 3 groups: “very early” with door-to-balloon time of less than 90 minutes (n=263); “early” between 90 minutes and 24 hours (n=790); and “late” with a time over 24 hours (n=497).

Within the 3 groups, there were significant differences in baseline characteristics. There was a higher occurrence of co-morbidities and older age in patients who underwent “late” angiograms and increased prevalence of cardiogenic shock and higher troponin levels in the “very early” group. The results of the study show that patients who underwent “late” angiograms had significantly longer lengths of stay, while patients who underwent “very early” angiograms had a significantly higher rate of bleeding. At 30 days, patients who underwent “very early” angiograms had a higher rate of death. At 1-year, higher mortality was seen in the “very early” and “late” patient groups.

The research team concluded that while it is reasonable that very early revascularization is beneficial in high-risk populations, there are insufficient data to support a very early invasive approach for NSTEMI. Unfortunately, the study cannot definitively answer the question of whether revascularization within 90 minutes will improve outcomes in patients with NSTEMI.

The American Journal In Cardiology, DOI: 10.1016/j.amjcard.2019.10.012