News | Cath Lab | May 16, 2017

Early Treatment for NSTEMI Patients Shows Greater Rate of Survival

First time an analysis demonstrates reduction in mortality between early and late intervention

Early Treatment for NSTEMI Patients Shows Greater Rate of Survival

May 16, 2017 — An analysis of non ST-elevation myocardial infarction (NSTEMI) patients who undergo coronary revascularization within 24 hours of hospitalization showed an increased reduction in mortality, marking the first time this difference has been demonstrated. Results from “Outcomes of Early vs. Late Revascularization in Low and High-Risk Patients Hospitalized with Non-ST-Elevation Myocardial Infarction: The Atherosclerosis Risk in Communities (ARIC) Surveillance Study” were presented as a late-breaking clinical trial at the Society for Cardiovascular Angiography and Interventions (SCAI) 2017 Scientific Sessions, May 10-13 in New Orleans.

NSTEMI is a type of heart attack that occurs when an artery is only partially blocked as opposed to a STEMI, where there is a complete blockage of the artery, making it the more severe of the two types.

While current guidelines recommend early intervention — defined as less than 24 hours — for STEMI patients, a delayed or late strategy — defined as between 24–72 hours — for NSTEMI is considered reasonable, unless there are extenuating circumstances, such as refractory angina or other conditions that put the patient in a higher risk category.

However, the optimum time for coronary revascularization of NSTEMI patients is under debate, according to Sameer Arora, M.D., of the University of North Carolina at Chapel Hill, Division of Cardiology and the study’s lead investigator. Evidence for current recommendations is based on clinical trials in controlled settings and selected patients.

Arora and his collaborators looked at data from the ARIC Community Surveillance Study, a large, ongoing investigation that began in 1987 involving 21 hospitals in four states: Maryland, Minnesota, Mississippi and North Carolina. Arora analyzed data from hospitalized NSTEMI patients undergoing coronary revascularization, and classified them as low- or high-risk, based on accepted risk scores. The survival benefit of an early revascularization (<24 hours after symptoms start) versus a late revascularization was analyzed using statistical models.

From 1987–2012, 9,960 patients were hospitalized with NSTEMI and underwent revascularization (67 percent percutaneous intervention, 28 percent bypass surgery and 5 percent thrombosis). Most were white (81 percent), male (69 percent), with a mean age of 62; approximately half (54 percent) were classified as low-risk. The overall 28-day mortality was 3 percent and most revascularizations (66 percent) were late.

After adjusting for confounding variables, such as diabetes and hypertension among others, early intervention was associated with an 87 percent lower mortality for low-risk patients (OR = 0.13; 95 percent CI: 0.02 – 0.93; p=0.04) and a 38 percent lower mortality for high-risk patients (OR = 0.62; 95 percent CI: 0.40 – 0.94; p=0.04). The association was consistent regardless of sex, race, or year of hospitalization.

Arora noted, “What we observed was both low- and high-risk NSTEMI patients who were treated within 24 hours of symptom onset had a 28-day survival benefit. To our knowledge, no clinical trials to date have reported a survival benefit related to early versus late revascularization.”

Arora reported no disclosures.

For more information: www.scaiscientificsessions.org

Related Content

Videos | Cath Lab| January 04, 2018
Bernadette Speiser, BSN, MSN, CCRN, RCIS, a cardiac cath/EP nurse at Palo Alto Veterans Hospital, Palo Alto, Calif.,
FDA Initiates Class I Recall of Sterilmed Reprocessed Agilis Steerable Introducer Sheath
News | Cath Lab| January 04, 2018
The U.S. Food and Drug Administration (FDA) announced a Class I recall of Sterilmed’s Agilis Steerable Introducer...
The California Heart & Vascular Clinic in El Centro, Calif., treated the first post-FDA clearance patient with a DABRA atherectomy system. Athar Ansari, M.D.

The California Heart & Vascular Clinic in El Centro, Calif., treated the first post-FDA clearance patient with a DABRA system. 

Feature | Cath Lab| November 24, 2017 | Athar Ansari, M.D., FACC
As debates about the current state and future of healthcare rage in Congress, the media and healthcare settings acros
Videos | Cath Lab| November 08, 2017
Juan Granada, M.D., Cardiovascular Research Foundation president and chief executive officer, shares his insights on
Results of the ORBITA study found no difference in exercise time after six weeks in patients with stable angina who received percutaneous coronary intervention (PCI) versus a placebo treatment. TCT 2017
Feature | Cath Lab| November 06, 2017
November 6, 2017 – Results from ORBITA, a prospective multi-center randomized blinded placebo-controlled study, found
Culprit Lesion-Only PCI Improves Outcomes for Cardiogenic Shock Patients Compared to Multivessel PCI
News | Cath Lab| November 01, 2017
November 1, 2017 — Results from the prospective, randomized, multicenter CULPRIT-SHOCK trial found an initial strateg
Three-Year Quality of Life Improvements Similar for PCI and CABG in Left Main Disease
News | Cath Lab| October 30, 2017
October 30, 2017 — New study results from the EXCEL trial comparing the quality of life (QoL) of patients with left m
Corindus Evaluates Incorporating HeartFlow Technology With CorPath GRX System
Technology | Cath Lab| October 26, 2017
Corindus Vascular Robotics Inc. announced that it will incorporate the HeartFlow FFRct (fractional flow reserve-...
Shockwave Medical Announces $35 Million in New Financing
News | Cath Lab| October 24, 2017
October 24, 2017 — Shockwave Medical reported $35 million in new financing, an extension of the company’s previously
Overlay Init