Comparison of patients with NSTE-ACS undergoing percutaneous coronary angiographywithin vs. beyond 72 hours
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Abstract
BACKGROUND: Current Thai acute coronary syndrome (ACS) guidelines recommend that high-risk non-ST-elevation acute coronary syndrome (NSTE-ACS) patients undergo percutaneous coronary intervention (PCI) within 72 hours. However, limited healthcare resources often delay this intervention.
OBJECTIVE: This study aims to compare outcomes between early PCI (≤72 hours) and delayed PCI (>72 hours) in high-risk NSTE-ACS patients.
METHODS: A retrospective study was conducted on high-risk NSTE-ACS patients who were admitted to Chiangrai Prachanukroh Hospital form 1 July 2019 to 31 December 2020. Patient data were analyzed using descriptive statistics, Fisher’s exact test, and the Mann–Whitney U-test to examine clinical characteristics and treatment outcomes between patients who underwent coronary angiography within 72 hours and those who underwent the procedure after 72 hours. A P-value of less than 0.05 was considered statistically significant.
RESULTS: Among 193 patients included, 180 (93.26%) had elevated cardiac troponin levels, and 172 (89.12%) exhibited dynamic ST-T changes, with a median GRACE score of 118 ± 28. Only 38 patients (19.69%) underwent PCI within 72 hours. Early PCI was associated with a shorter hospital length of stay compared to delayed PCI (3 days [IQR 2,5] vs. 5 days [IQR 3,7], p < 0.001). However, no significant differences were observed in all-cause mortality at 1 month (2.63% vs. 2.58%, p = 0.249) and 6 months (2.63% vs. 3.87%, p = 0.529).
CONCLUSIONS AND RECOMMENDATIONS: Undergoing PCI within 72 hours was associated with a shorter hospital length of stay, but did not impact mortality rates at 1 month and 6 months. Due to the limitations of this study, further research involving a larger Thai population may be necessary to assess the outcomes of timely PCI, particularly in the context of limited resources and medical personnel in Thailand, which has led to many NSTE-ACS patients not receiving treatment according to clinical practice guidelines.
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