Optimal timing of percutaneous coronary intervention for non-ST elevated myocardial infarction with congestive heart failure

• Published in: Cardiovascular revascularization medicine 2024-10, Vol.67, p.87-93
• Main Authors: Lim, Yongwhan, Kim, Min Chul, Ahn, Joon Ho, Lee, Seung Hun, Hyun, Dae Young, Cho, Kyung Hoon, Sim, Doo Sun, Hong, Young Joon, Kim, Ju Han, Jeong, Myung Ho, Choi, Ik Jun, Choo, Eun Ho, Lim, Sungmin, Hwang, Byung-Hee, Park, Mahn-Won, Kim, Chan Joon, Park, Chul Soo, Kim, Hee Yeol, Chang, Kiyuk, Ahn, Youngkeun
• Format: Article
• Language: English
• Subjects: Aged; Congestive heart failure; Female; Heart Failure - complications; Heart Failure - diagnosis; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - therapy; Hospital Mortality; Humans; Male; Middle Aged; Non-ST Elevated Myocardial Infarction - diagnosis; Non-ST Elevated Myocardial Infarction - diagnostic imaging; Non-ST Elevated Myocardial Infarction - mortality; Non-ST Elevated Myocardial Infarction - therapy; Non-ST segment elevation myocardial infarction; Patient Readmission; Percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - mortality; Prospective Studies; Registries; Republic of Korea; Risk Assessment; Risk Factors; Shock, Cardiogenic - diagnosis; Shock, Cardiogenic - etiology; Shock, Cardiogenic - mortality; Shock, Cardiogenic - physiopathology; Shock, Cardiogenic - therapy; Time Factors; Time-to-Treatment; Timing; Treatment Outcome
• ISSN: 1553-8389; 1878-0938; 1878-0938
• DOI: 10.1016/j.carrev.2024.04.295

This study investigated the optimal timing for percutaneous coronary intervention (PCI) in patients with NSTEMI complicated by heart failure (HF). In total, 762 patients with NSTEMI and HF in a multicenter, prospective registry in South Korea were classified according to the Killip classification (Killip class 2, n = 414 and Killip class 3, n = 348) and underwent early (within 24 h) and delayed (after 24 h) PCI. The primary outcome was all-cause mortality which was further analyzed with landmark analysis with two months as a cut-off. Secondary outcomes were cardiovascular death, in-hospital cardiogenic shock (CS), readmission due to HF, and acute myocardial infarction during follow-up. Delayed PCI was associated with lower rates of 2-month mortality (6.1 % vs. 15.8 %, p = 0.007) and in-hospital CS (4.3 % vs. 14.1 %, p = 0.003), along with lower risks of 2-month mortality (hazard ratio [HR] = 0.38, 95 % confidence interval [CI] = 0.18–0.83, p = 0.014), in-hospital CS (HR = 0.29, 95 % CI = 0.12–0.71, p = 0.006) in multivariate Cox models of Killip class 3 patients. There was no statistical difference of incidence and risk of all predefined outcomes according to varying timing of PCI in Killip 2 patients. Based on these results, the timing of PCI in patients with NSTEMI complicated by HF should be determined based on HF severity. Delayed PCI should be considered in patients with NSTEMI and more severe HF. •In the COREA-AMI registry, 45.7% of the patients were treated with delayed PCI (> 24 h) for NSTEMI complicated by CHF.•The 2-month mortality analysis showed distinct associations between PCI timing and Killip classification (2 or 3).•Delayed PCI was associated with lower rates and risk of 2-month mortality and in-hospital CS in Killip class 3 patients.•There was no statistical difference of mortality and other outcomes according to timings of PCI in Killip 2 patients.