Abstract 15663: The Clinical Impact of Early Invasive Strategy on Non-ST-Segment Elevation Myocardial Infarction According to the Time-Varying Patterns of Cardiac Biomarker
Background: The clinical benefit of early invasive strategy in patients with non-ST-segment elevation myocardial infarction (NSTEMI) is still left uncertain. We sought to evaluate the clinical impact of early invasive strategy on NSTEMI patients according to the time-varying patterns of cardiac biomarker.
Methods: This trial included 336 consecutive NSTEMI patients received percutaneous coronary intervention (PCI), and they were classified into two groups according to the changing pattern of cardiac biomarkers at first follow-up assessment: group I: rising pattern of both CK-MB and troponin I (n=164), group II: falling pattern of CK-MB and/or troponin I (n=172). The primary endpoint was 12-month major cardiac and cerebrovascular events (MACCE). We compared incidence of MACCE between early (<12 hours after arrival) and delayed (≥12 hours) PCI in each group.
Results: There were no statistically significant differences of baseline characteristics between group I and II. The rates of 12-month MACCE were not different between early and delayed PCI group (5.7% vs. 12.9%, p = 0.068) in all study subjects. Similarly, early PCI had similar rates of MACCE compared with delayed PCI in group II (12.5% vs. 13.6%, p = 0.872). But, patients treated with early PCI had significantly lower rates of 12-month MACCE in group I (1.8% vs. 11.9%, p = 0.029). Also, the MACE-free survival rates were significantly lower in early PCI compared with delayed PCI in group I (98.2% vs. 88.1%, log rank p = 0.032)(Figure)
Conclusions: Early invasive strategy was associated with better clinical outcomes at 12-month follow-up in NSTEMI patients with rising pattern of cardiac biomarker.
- © 2013 by American Heart Association, Inc.