Relation of Timing of Percutaneous Coronary Intervention on Outcomes in Patients With Non-ST Segment Elevation Myocardial Infarction
Section snippets
Methods
VCOR was established in 2013 as a state-wide clinical quality registry in Victoria, Australia, with all 32 public and private PCI capable centers contributing from 2017. VCOR is managed by Monash University and is represented by a steering committee constituted by specialists from contributing centers. The full VCOR methodology is described elsewhere.9 VCOR is ethics approved and operates with an opt-off consent process. Following VCOR research and local institutional ethics committee approvals
Results
Of the 11,852 consecutive patients who underwent PCI for NSTEMI between January 2014 and December 2018, 2,178 (18.4%) underwent PCI <24 hours from symptom onset, 5,434 (45.8%) underwent PCI 24 to 72 hours from symptom onset, and 4,240 (35.8%) underwent PCI >72 hours from symptom onset. Patients waiting longer for PCI were older, more likely to be female, and more commonly had co-morbidities such as diabetes mellitus, peripheral vascular disease, cerebrovascular disease, poor renal function, and
Discussion
This study of a large contemporary cohort of patients who underwent PCI for NSTEMI demonstrated that only 18.4% of patients underwent PCI within the guideline recommended 24-hour window, with 35.8% patients who underwent PCI outside 72 hours. Patients who underwent earlier revascularization had fewer high-risk characteristics overall, apart from those that presented with cardiogenic shock or OHCA requiring intubation. A higher rate of mortality was observed in patients who underwent PCI <24
Authors’ Contributions
Riley J. Batchelor: Conceptualization, Methodology Investigation, Writing – Original Draft, Visualization
Diem Dinh: Methodology, Software, Formal analysis, Data curation, Writing – Review & Editing
Angela Brennan: Data curation, Writing – Review & Editing, Project administration
Nathan Wong: Writing – Review & Editing
Jeffrey Lefkovits: Validation, Data curation, Writing – Review & Editing
Christopher Reid: Validation, Data curation, Writing – Review & Editing
Stephen J. Duffy: Validation, Data
Disclosures
The authors declare that they have no known competing financial interests or personal relations that could have appeared to influence the work reported in this study.
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The Victorian Cardiac Outcomes Registry (VCOR) was funded by Medibank Private from 2011 to 2014, in addition the Victorian Department of Health and Human Services have provided funding since 2012, with Monash University providing in-kind funding. Professor Reid is supported by a NHMRC Principal Research Fellowship (reference no. 11136372). Professor Duffy's work is supported by a NHMRC grant (reference no. 1111170). Associate Professor Stub is supported by an NHF Future Leader Fellowship (reference no. 101908), and a Viertel Foundation Clinical Investigator award.