MAJOR ADVERSE CARDIOVASCULAR EVENTS COMPARISON BETWEEN ACCEPTED VERSUS DENIED INVASIVE CORONARY EVALUATION IN NSTEMI PATIENTS.

Sen DM, Naresh

Background
Recurrent ischemia is a common problem in a case of non–ST-segment elevation acute myocardial infarction. Coronary angiography is most accurate diagnostic tool to decide for revasculaization or medical management. Our study was done for review of importance of early coronary angiography with revascularization of significant coronary artery disease to reduce majar cardiovascular adverse events (MACE).

Methods
We enrolled(n=4772) and divided the early group received angiography within 3 hours (Group-A) 28% ,a delayed group received angiography 12 to 48 hours (Group-B)36% and third group was denied for angiography( Group-C) 34% due to different reasons after NSTEMI . Regarding the primary endpoint at 30 days and at 6 months , which is a composite of cardiovascular death and recurrent ischemic event. All groups had similar baseline characteristics, such as history of MI, Hypertension, Diabetes, and aspirin and P2Y12-ADP use.

Results
On average, angiography was done within 1.5 hour in the early group and at 19.5 hours in the delayed group. Percutaneous coronary intervention (PCI) was performed on 57% of the study population, 10 % underwent coronary artery bypass grafting(CABG) and 33 % received medical therapy. The MACE rate was 3.6% in the early group ,12.8% in the delayed and 29.3% in the denied group. Rates of recurrent ischemic events were 3.2% for the early group , 11.5% for the delayed group and 19.4 % for the denied group during hospitalization, and 5.0% , 17.4% & 28,6% at 30 days and 5.0% , 17.4% & 28,6% at 6 months. Rates of cardiovascular death were 0.8% for the early group , 1.5% for the delayed group and 7.2 % for the denied group during hospitalization, and 1.5% , 3.4% & 13.6% at 30 days and 3.0% , 7.1% & 21.4% at 6 months.

Conclusions
Study revealed fourfold lower rate of MACE in the early group compared to delayed group and tenfold lower rate of MACE compared to denied group. The positive effect of early revascularization in early diagnosed patients was beneficial to reduce rate of recurrent ischemia and death .