Author + information
- Alejandro Lemor,
- Abel Casso Dominguez,
- Shawn Lee,
- Carlos Gongora,
- Farid Gholitabar and
- Davendra Metha
Background: Current management for non-ST-segment myocardial infarction (NSTEMI) includes an invasive approach, however the optimal timing of invasive therapy remains less well defined than for ST-segment elevation MI. We aim to evaluate the clinical impact of early versus delayed invasive intervention in patients 80 years old and older with NSTEMI.
Methods: This is a retrospective cohort study of adult patients older than 80 years old who were hospitalized in 2013 with NSTEMI; patients were selected from the Nationwide Inpatient Sample (NIS) database. The patients were classified in two groups, an early-intervention group (invasive intervention within 24 hours) and a delayed-intervention group (invasive intervention >24 hours). The primary outcome was in-hospital mortality. Secondary outcomes included admission to intensive care unit (ICU), shock, acute respiratory failure (ARF), and mean total hospital charges. Results were adjusted for age, gender, Charlson Comorbidity Index and hospital bed size.
Results: The study included 107,380 patients older than 80 years with NSTEMI, a total of 13,330 patients underwent early-intervention and 94,050 underwent delayed-intervention. Seven percent of patients died (7,570/107,380) during the hospital admission. Early intervention reduced inpatient mortality by 42 percent when compared with delayed intervention (OR: 0.58, p<0.00). The rate of shock was significantly higher in the early intervention group (OR: 1.30, p=0.00) as well as the total hospital charges ($86,371 vs $53,362; p<0.00). Patients with an early intervention had lower rates of ARF (OR: 0.68, p>0.00). There was no significant difference among the rates of admission to ICU (OR: 1.08, p=0.48).
Conclusions: Invasive intervention within 24 hours of hospitalization significantly reduces inpatient mortality and acute respiratory failure for patients older than 80 years old admitted with NSTEMI, but leads to higher rates of shock and increase hospital charges. A prospective investigation with a large sample, and long clinical follow-up is required to evaluate the long-term benefits of this strategy.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: PCI for NSTEMI and Complex Patients With Multiple Co-Morbidities
Abstract Category: 19. Interventional Cardiology: Complex Patients/Comorbidities
Presentation Number: 1154-132
- 2017 American College of Cardiology Foundation