Evolution of Patients with Myocardial Infarction without ST-Segment Elevation Depending on the Time of Coronarography
Authors: Cozma Alexandra , Babes Katalin , Ioachim P.M. , Ardelean Adriana 
Published: November 2020

Abstract

Introduction. The standard treatment for myocardial infarction is percutaneous revascularization. In patients with STEMI, is recommended an approach as early as possible, being established a period of less than 2 hours from the moment of diagnosis. Things are not as clear regarding myocardial infarction without ST segment elevation. The current guideline proposes to divide the patients with NSTEMI into 4 risk groups, and to perform coronarography in a range of less than 2 hours up to over 72 hours, depending on the risk group of which the patient is part. Several studies have been conducted to determine the benefit of an invasive approach to the detriment of current recommendations, but no consensus has been reached so far.

Objective. The present study aims to analyze the short and medium term evolution, of a group of 125 patients, with NSTEMI, depending on the time of coronarography.

Material and methods. We have analyzed all cases of NSTEMI, admitted in our hospital, between 1.01.2017-31.12 2017. The following parameters were noted: age, sex, presence of cardiovascular risk factors; personal pathological history, previous treatment, Killip class, GRACE score, left ventricular ejection fraction at admission, risk group, the moment of the coronarography.We have followed: complications, number of days of hospitalization, in-hospital and one year mortality.

Results. Of the 125 patients with NSTEMI, 86 (68.8%) were men. They were divided into 4 risk groups as follows: very high risk (n =31; 16.8%), high risk (n =80; 43.5%), medium (n =58; 31.5%) and low risk (n =15; 8.2%). Coronarography was performed in the first 2 hours after presentation in 13 cases (10.40%), in 24 hours for 48 cases (38.40%), between 24-72 hours in 26 patients (20.80%) and late, after 72 hours in 38 patients (30.40%). Most commonly, coronarography was performed in the first 24 hours in patients in Killip I and II classes. Depending on the risk group, 11 of the 15 patients (73.34%) with very high risk received emergency angiography (within the first 24 hours). In contrast, high risk patients performed the procedure after 24 hours. During the hospitalization, 19 patients (15.20%) had complications. The multivariate analysis shows that the most powerful predictors for the onset of complications were age (p =0.02), Grace score (p =0.004) and the risk group in which the patient is classified. The timing of PCI did not influence the appearance of complications. The number of hospitalization days was 5.92±3.56 days in patients who had PCI under 2 hours, 7.47±5.41 days for those who received the procedure in 24 hours, 7.80±3.67 days between 24-72 hours, 10.28±3.79 for those who performed the procedure late. Applying multiple regression, the most powerful predictors for the number of hospitalization days were age, time of PCI and GRACE score. Intra-hospital mortality was 1.6%, and 11.20% at 1 year. Multiple regression showed that among the variables studied, the predictors for death at 1 year were the complications that occurred and the risk class of the patients.

Conclusion. Performing early coronarography in patients with NSTEMI may represent a cost-effective strategy, by reducing the number of days of hospitalization, but it does not influence the rate of complications, nor the short and medium term mortality. In contrast, the age and the GRACE score are predictors of the cardio-vascular complications. Short- and medium-term mortality is correlated with the risk group and with the complications that occurred during the hospitalization.