Journal List > Korean Circ J > v.38(1) > 1016329

TOOLS
An, Park, Lee, Jang, Lee, Ha, Lee, Kim, Kim, Chun, Hong, and Shin: Prognosis According to the Timing of Percutaneous Coronary Intervention in an Acute Non-ST Segment Elevation Myocardial Infarction
Original Article
Korean Circulation Journal

Korean Circulation Journal 2008; 38(1): 23-28.

Published online: 31 January 2008

DOI: https://doi.org/10.4070/kcj.2008.38.1.23

Prognosis According to the Timing of Percutaneous Coronary Intervention in an Acute Non-ST Segment Elevation Myocardial Infarction

Sung Gyu An, MD, Tae Ik Park, MD, Sang Hyun Lee, MD, Hyung Ha Jang, MD, Dong Won Lee, MD, Jae Kyung Ha, MD, Han Cheol Lee, MD, Jun Kim, MD, June Hong Kim, MD, Kook Jin Chun, MD, Taek Jong Hong, MD, Yung Woo Shin, MD

Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea.

Correspondence: Taek Jong Hong, MD, Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, 10 Ami-dong 1-ga, Seo-gu, Busan 602-739, Korea. Tel: 82-51-240-7220, Fax: 82-51-254-3127, md-phd@hanmail.net

Received 13 March 2007       Revised 9 August 2007       Accepted 31 August 2007

Copyright © 2008 The Korean Society of Cardiology

Abstract

Background and Objectives

An early invasive strategy with coronary angiography and revascularization is currently the recommended treatment for patients at high risk with an acute non-ST-segment elevation myocardial infarction (NSTEMI). In this early invasive strategy, percutaneous coronary intervention (PCI) is generally recommended within 48 hours, but there is little data on earlier intervention in intermediate risk patients.

Subjects and Methods

We studied retrospectively the past medical records of 118 patients at intermediate risk that were admitted at Pusan National University Hospital and were stratified by the time interval from chest pain onset to PCI (Group I: <24 hr; Group II: 24-48 h; Group III: >48 h). Clinical outcomes were evaluated in terms of in-hospital and 12 months follow-up of a major adverse cardiac event (MACE).

Results

Baseline characteristics were not different statistically among the three groups, except for the use of tirofiban. There were no in-hospital deaths or myocardial infarctions (MI) in Group I and Group II patients, but there were three cases of in-hospital deaths in Group III patients. The incidence of a 12-month MACE was 0% in Group I patients, 6.7% (one revascularization) in Group II patients and 17.1% (3 deaths, 3 MIs, 7 revascularizations) in Group III patients (p=0.043).

Conclusion

In acute NSTEMI, the incidence of a 12-month MACE was lower in the intermediate risk group when PCI was performed in the early period. Early PCI could be recommended in acute NSTEMI on the basis of the status of individual patients.

Keywords: Myocardial infarction, Angioplasty, transluminal, percutaneous coronary, Early intervention

Figures and Tables

Fig. 1
In-hospital major adverse cardiovascular events (MACE).
kcj-38-23-g001
Fig. 2
Major adverse cardiac events (MACE) free survival curve.
kcj-38-23-g002
Table 1
Demographic datas and clinical characteristics
kcj-38-23-i001

TIMI: thrombolysis in myocardial infarction, hs-CRP: high sensitivity-C reactive protein, LV dysfunction: left ventricle dysfunction, EF: ejection fraction, ACE: angiotensin converting enzyme

Table 2
Coronary angiographic findings and percutaneous coronary interventions
kcj-38-23-i002

CAD: coronary artery disease, TIMI: thrombolysis in myocardial infarction, ACC: American College of Cardiology, AHA: American Heart Association, PCI: percutaneous coronary intervention, BMS: bare metal stent, DES: drug eluting stent, RCA: right coronary artery, LCX: left circumflex artery, LAD: left anterior decending artery

Table 3
Incidence of major adverse cardiac events during 12 months
kcj-38-23-i003

MACE: major adverse cardiovascular events, MI: myocardial infaction, TVR: target vessel revascularization

References

1. Bertrand ME, Simoons ML, Fox KA, et al. Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2002. 23:1809–1840.
2. Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction-summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol. 2002. 40:1366–1374.
3. Fragmin and Fast Revascularization During InStability in Coronary artery disease Investigators. Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC-II prospective randomized multicenter study. Lancet. 1999. 354:708–715.
4. Wallentin L, Lagerqvist B, Husted S, Kontny F, Stahle E, Swahn E. Outcome at 1 year after an invasive compared with a non-invasive strategy in unstable coronary-artery disease. Lancet. 2000. 356:9–16.
5. Lagerqvist B, Husted S, Kontny F, et al. A long-term perspective on the protective effects of an early invasive strategy in unstable coronary artery disease: two-year follow-up of the FRISC-II invasive study. J Am Coll Cardiol. 2002. 40:1902–1914.
6. Cannon CP, Weintraub WS, Demopoulos LA, et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med. 2001. 344:1879–1887.
7. Diderholm E, Andren B, Frostfeldt G, et al. The prognostic and therapeutic implications of increased Troponin T levels and ST depression in unstable coronary artery disease. Am Heart J. 2002. 143:760–767.
8. Lagerqvist B, Diderholm E, Lindahl B, et al. The FRISC score for selection of patients for an early invasive treatment strategy in unstable coronary artery disease. Heart. 2005. 91:1047–1052.
9. Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantification of the left ventricle by two dimensional echocardiography. J Am Soc Echocardiogr. 1989. 2:358–367.
10. Quinones MA, Waggoner AD, Reduto LA, et al. A new simplified and accurate method for determining ejection fraction with two dimensional echocardiography. Circulation. 1981. 64:744–753.
11. Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA. 2000. 284:835–842.
12. Grech ED, Ramsdale DR. Acute coronary syndrome: unstable angina and non-ST segment elevation myocardial infarction. BMJ. 2003. 326:1259–1261.
13. Fox KA, Poole-Wilson PA, Henderson RA, et al. Interventional versus conservative treatment for patients with unstable angina or non-ST-elevation myocardial infarction. Lancet. 2002. 360:743–751.
14. Boden WE, O'Rourke RA, Crawford MH, et al. Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy. N Engl J Med. 1998. 338:1785–1792.
15. Neumann FJ, Kastrati A, Pogatsa-Murray G, et al. Evaluation of prolonged antithrombotic pretreatment ("cooling-off" strategy) before intervention in patients with unstable coronary syndromes: a randomized controlled trial. JAMA. 2003. 290:1593–1599.
16. Yeghiazarians Y, Braunstein JB, Askari A, Stone PH. Unstable angina pectoris. N Engl J Med. 2000. 342:101–114.
17. Boden WE. "Routine invasive" versus "selective invasive" approaches to non-ST-segment elevation acute coronary syndromes management in the post-stent/platelet inhibition era. J Am Coll Cardiol. 2003. 41:113S–122S.
18. Jeong JH, Chun KJ, Park YH, et al. The safty of tirofiban therapy in patients with acute coronary syndrome. Korean Circ J. 2004. 34:558–564.
19. Park DW, Park SW. Stent thrombosis in the era of the drug-eluting stent. Korean Circ J. 2005. 35:791–794.
TOOLS
Similar articles