Clinical Research
Invasive and Interventional Cardiology
Impact of Delay to Angioplasty in Patients With Acute Coronary Syndromes Undergoing Invasive Management: Analysis From the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) Trial

https://doi.org/10.1016/j.jacc.2009.11.063Get rights and content
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Objectives

The aim of this study was to determine the impact of delay to angioplasty in patients with acute coronary syndromes (ACS).

Background

There is a paucity of data on the impact of delays to percutaneous coronary intervention (PCI) in patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS) undergoing an invasive management strategy.

Methods

Patients undergoing PCI in the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) trial were stratified according to timing of PCI after clinical presentation for outcome analysis.

Results

Percutaneous coronary intervention was performed in 7,749 patients (median age 63 years; 73% male) with NSTE-ACS at a median of 19.5 h after presentation (<8 h [n = 2,197], 8 to 24 h [n = 2,740], and >24 h [n = 2,812]). Delay to PCI >24 h after clinical presentation was significantly associated with increased 30-day mortality, myocardial infarction (MI), and composite ischemia (death, MI, and unplanned revascularization). By multivariable analysis, delay to PCI of >24 h was a significant independent predictor of 30-day and 1-year mortality. The incremental risk of death attributable to PCI delay >24 h was greatest in those patients presenting with high-risk features.

Conclusions

In this large-scale study, delaying revascularization with PCI >24 h in patients with NSTE-ACS was an independent predictor of early and late mortality and adverse ischemic outcomes. These findings suggest that urgent angiography and triage to revascularization should be a priority in NSTE-ACS patients.

Key Words

acute coronary syndrome
PCI
timing

Abbreviations and Acronyms

CABG
coronary artery bypass grafting
MI
myocardial infarction
NSTE-ACS
non–ST-segment elevation acute coronary syndrome
PCI
percutaneous coronary intervention
TIMI
Thrombolysis In Myocardial Infarction

Cited by (0)

Dr. Gersh is a member of the Data Safety Monitoring Board for Boston Scientific, Abbott Laboratories, Bristol-Myers Squibb, and AstraZeneca, and is a stock shareholder for CV Therapeutics. Dr. Tcheng is on the Scientific Board for Schering-Plough, and on the Speakers' Bureau for Schering-Plough and Eli Lilly. Dr. Stone is on the advisory board for Abbott Vascular and Boston Scientific.