Abstract 2077: Shortening Time to Cardiac Catheterization Is Associated with Improved Outcomes Among Patients with Non-ST-segment Elevation Acute Coronary Syndromes: Results from the Randomized SYNERGY Trial
Background: Optimal timing of cardiac catheterization remains unclear. We evaluated the relation between time from hospital admission to cath (TTC) and outcomes among NSTE ACS patients who received an early invasive strategy (cath ≤ 48h).
Methods: We analyzed data from 9978 patients enrolled in the SYNERGY trial. Patients had at least 2 of the following: age ≥ 60 yrs, positive markers, ST deviation ≥ 1mm. Patients were grouped by 6-hour TTC intervals. Primary outcomes were 30-day death or MI (D/MI) and major bleeding. Unadjusted and adjusted estimates of event rates were determined for each TTC period. Adjusted for baseline and post-baseline variables OR (95% CI) were calculated for each time period using a landmark analysis in which the reference group contains all patients in all later TTC groups.
Results: 9216 patients (92%) underwent cath; 6352 (64%) within 48h. Admission to US hospitals and white race were predictors of shorter TTC; admission on Friday/Saturday and older age were predictors of delayed cath. Upstream GP IIb/IIIa use increased with delayed TTC. Unadjusted and adjusted rates of D/MI increased with increasing TTC (Figure⇓). The adjusted OR of D/MI for pts with TTC <6h was 0.56 (0.41– 0.76), while after 30h there was no significant benefit compared with a further delayed cath. Adjusted bleeding rates were 4.2% for TTC <6h and 4.8% for TTC 42– 48h and were not significantly different among TTC groups.
Conclusion: Shortening TTC was associated with fewer ischemic outcomes and no increase of bleeding. Clinical trials are needed to clarify whether delaying cath to administer aggressive upstream antithrombotic therapies is beneficial in the setting of NSTE ACS management.