Coronary artery disease
Relation of Timing of Cardiac Catheterization to Outcomes in Patients With Non–ST-Segment Elevation Myocardial Infarction or Unstable Angina Pectoris Enrolled in the Multinational Global Registry of Acute Coronary Events

https://doi.org/10.1016/j.amjcard.2005.02.004Get rights and content

We assessed whether timing of catheterization is associated with the type of non-ST-segment elevation acute coronary syndrome and/or outcome in patients who were enrolled in the Global Registry of Acute Coronary Events. Overall, 8,853 patients who had unstable angina pectoris or non-ST-elevation myocardial infarction were categorized according to timing of catheterization: expeditive (<24 hours), early (24 to 48 hours), and delayed (>48 hours). Patients in the delayed group were older, more frequently had previous myocardial infarction or stroke, and had a higher risk score compared with those in the expeditive and early groups (all p ≤0.001). Killip class IV at admission, non-ST-elevation myocardial infarction, and Q waves after the index electrocardiogram were more common in the expeditive group (all p <0.0001). Patients in the expeditive and early groups were treated more aggressively with medications than were those in the delayed group. The in-hospital composite end point (death, stroke, or major bleed) occurred most frequently in the expeditive group (expeditive 6.6%, early 3.9%, delayed 5.1%, p = 0.0005), as did in-hospital death (expeditive 3.5%, early 1.4%, delayed 2.0%, p <0.0001). The highest incidence of death during follow-up occurred in the delayed group (3.8% delayed vs 2.8% expeditive/early, p = 0.0210). Multivariate regression analysis suggested that expeditive catheterization was related to in-hospital death and death from time of catheterization to 6 months. We conclude that expeditive catheterization is associated with unstable presenting features that contribute significantly to the higher risk of death and death or myocardial infarction in hospital compared with patients who undergo later catheterization.

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Methods

Full details of the Global Registry of Acute Coronary Events methods have been published (www.outcomes.org/grace).11, 12, 13 Currently, 94 hospitals in 14 countries are participating in the Global Registry of Acute Coronary Events. Patients entered in the registry had to be ≥18 years old and alive at the time of hospital presentation, be admitted for ACS as a presumptive diagnosis (i.e., have symptoms consistent with acute ischemia), and have ≥1 of the following: electrocardiographic changes

Patient characteristics

A total of 33,202 patients who had ACS were enrolled in the Global Registry of Acute Coronary Events between April 1999 and September 2003. Of these, 11,281 were diagnosed with unstable angina pectoris and 9,775 with NSTEMI. Of patients who had unstable angina pectoris and NSTEMI, 51.6% underwent catheterization. Data on the timing of catheterization were available in 8,853 patients who were then categorized into expeditive, early, and delayed catheterization groups (Table 1).

More than 66% of

Discussion

Observational data from large-scale registries such as the Global Registry of Acute Coronary Events have provided useful information about “real-life” patient populations and clinical management practices.13, 14 The present analysis used data from patients who had been hospitalized with a diagnosis of unstable angina pectoris or NSTEMI, had undergone early invasive management with standard catheterization procedures, and were enrolled in the Global Registry of Acute Coronary Events. Previously

Acknowledgment

The investigators express their gratitude to the physicians and nurses who participated in the Global Registry of Acute Coronary Events. Further information about the project and a complete list of the investigators can be found at www.outcomes.org/grace. Sanofi-Aventis, Bridgewater, New Jersey, had no involvement in the collection, analysis, and interpretation of data, in the writing of the report, and in the decision to submit the report for publication.

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The Global Registry of Acute Coronary Events is funded by an unrestricted educational grant from Sanofi-Aventis, Bridgewater, New Jersey, to the Center for Outcomes Research, University of Massachusetts Medical School, Worcester, Massachusetts.

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