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Early Invasive Strategy Based on the Time of Symptom Onset of Non-ST-Segment Elevation Myocardial Infarction

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Author(s)
SungA BaeJung-Joon ChaSubin LimJu Hyeon KimHyung Joon JooJae Hyoung ParkSoon Jun HongCheol Woong YuDo-Sun LimYongcheol KimWoong Chol KangEun Jeong ChoSang Yeub LeeSang Wook KimEun-Seok ShinSeung Ho HurSeok Kyu OhSeong-Hoon LimHyo-Soo KimYoung Joon HongYoungkeun AhnMyung Ho JeongTae Hoon Ahn
Keimyung Author(s)
Hur, Seung Ho
Department
Dept. of Internal Medicine (내과학)
Journal Title
JACC Cardiovasc Interv
Issued Date
2023
Volume
16
Issue
1
Keyword
all-cause mortalityinvasive coronary angiographymyocardial infarctionsymptom onset
Abstract
Background:
A limitation of the current guidelines regarding the timing of invasive coronary angiography for patients with non-ST-segment elevation acute coronary syndrome is the randomization time. To date, no study has reported the clinical outcomes of invasive strategy timing on the basis of the time of symptom onset.

Objectives:
The aim of this study was to investigate the effect of invasive strategy timing from the time of symptom onset on the 3-year clinical outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI).

Methods:
Among 13,104 patients from the Korea Acute Myocardial Infarction Registry-National Institutes of Health, 5,856 patients with NSTE myocardial infarction were evaluated. The patients were categorized according to symptom-to-catheter (StC) time (<48 or ≥48 hours). The primary outcome was 3-year all-cause mortality.

Results:
Overall, 3,919 patients (66.9%) were classified into the StC time <48 hours group. This group had lower all-cause mortality than the group with StC time ≥48 hours (7.3% vs 13.4%; P < 0.001). The lower risk for all-cause mortality in the group with StC time <48 hours group was consistent in all subgroups. Notably, emergency medical service use (HR: 0.31; 95% CI: 0.19-0.52) showed a lower risk for all-cause mortality than no emergency medical service use (HR: 0.54; 95% CI: 0.46-0.65; P value for interaction = 0.008).

Conclusions:
An early invasive strategy on the basis of StC time was associated with a decreased risk for all-cause mortality in patients with NSTEMI. Because the study was based on a prospective registry, the results should be considered hypothesis generating, highlighting the need for further research. (iCReaT Study No. C110016).
Keimyung Author(s)(Kor)
허승호
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1876-7605
Source
https://www.sciencedirect.com/science/article/pii/S1936879822018556?via%3Dihub
DOI
10.1016/j.jcin.2022.09.039
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/44860
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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