BACKGROUND: Several studies have shown that routine invasive strategies reduce major events compared to a conservative strategy for patients with acute coronary syndrome without ST elevation. However, the optimal time to institute this approach is still debatable. METHODS: From May 2003 to November 2005, 466 patients with myocardial infarction without ST elevation, excluding patients with hemodynamic instability, were treated by percutaneous coronary interventions (PCI) in our hospital. Patients were divided in 2 groups according to time from admission to PCI: 1) Early Group (<6 h) involving 152 patients and 2) Late Group (>6 h) including 314 patients. Procedure data and in-hospital mortality were analyzed. RESULTS: Baseline clinical characteristics were similar in both groups, except for prior CABG that was more frequent in late group. Median time from admission to PCI was 3 hours (interquartile interval: 2-4hours) in the Early Group and 23 hours (interquartile interval: 14-48hours) in the Late Group. In-hospital mortality was significantly reduced in the Early Group (0.7 vs. 4.8%; p=0.02). Age, heart failure and time from admission to PCI were independent predictors of in-hospital mortality by multivariate analysis. CONCLUSION: Early PCI for myocardial infarction without ST elevation seems to reduce the in-hospital mortality in the daily practice. The clinical impact of this accelerated invasive strategy needs to be evaluated in randomized trials.
Coronary disease; Myocardial infarction; Angioplasty, transluminal, percutaneous coronary; Stents
