Timing of Angiography and Outcomes in High-Risk Patients with Non-ST Segment Elevation Myocardial Infarction Managed Invasively: Insights from the TAO Trial
Background—In patients with non ST-elevation myocardial infarction (NSTEMI) and Global Registry of Acute Coronary Events (GRACE) score >140, coronary angiography (CAG) is recommended by European and American guidelines within 24h. We sought to study the association of a "very early" (i.e. ≤12h), early (12-24h) and delayed (>24h) CAG in NSTEMI with GRACE score >140 with ischemic outcomes.
Methods—The Treatment of Acute coronary syndrome with Otamixaban (TAO) trial randomized patients with NSTEMI and CAG scheduled within 72h to heparin plus eptifibatide versus otamixaban. In this post hoc analysis, patients with GRACE score > 140 were categorized into 3 groups according to timing of CAG from admission (<12h, ≥12h to <24h, ≥24h). The primary ischemic outcome was the composite of all-cause death and myocardial infarction (MI) within 180 days of randomization.
Results—CAG was performed in 4,071 patients (<12h n=1648 (40.5%), 12-24h n=1420 (34.9%), ≥24h n=1003 (24.6%)). With CAG ≥24h as a reference, CAG from 12 to 24 hours was not associated with a lower risk of primary ischemic outcome at 180 days (odds ratio (OR) 0.96, 95% confidence interval (CI) 0.75-1.23), whereas CAG <12h was associated with a lower risk of death and MI (OR 0.71, 95% CI 0.55-0.91). Performing CAG <12h was also associated with a lower risk of death and MI (OR 0.76, 95%IC 0.61-0.94; p=0.01) compared to CAG performed 12-24h. No difference was observed regarding bleeding complications.
Conclusions—In patients with high-risk NSTEMI, undergoing CAG within the initial 12 hours after admission (as opposed to later, either 12 to 24 h or ≥24 h) was associated with lower risk of ischemic outcomes at 180 days.
- Received June 2, 2017.
- Revision received July 17, 2017.
- Accepted August 16, 2017.