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Lee SD, Kim RB, Seo CO, Kim M, Lee HJ, Kim H, Kim HR, Kim K, Kang MG, Park JR, Hwang SJ, Hwang JY, Jeong MH, Hur SH, Cha KS, Koh JS. Very early vs delayed invasive strategy in high-risk NSTEMI patients without hemodynamic instability: Insight from the KAMIR-NIH. PLoS One 2024; 19:e0304273. [PMID: 38843207 PMCID: PMC11156373 DOI: 10.1371/journal.pone.0304273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/09/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND High-risk non-ST-elevation myocardial infarction (NSTEMI) patients' optimal timing for percutaneous coronary intervention (PCI) is debated despite the recommendation for early invasive revascularization. This study aimed to compare outcomes of NSTEMI patients without hemodynamic instability undergoing very early invasive strategy (VEIS, ≤ 12 hours) versus delayed invasive strategy (DIS, >12 hours). METHODS Excluding urgent indications for PCI including initial systolic blood pressure under 90 mmHg, ventricular arrhythmia, or Killip class IV, 4,733 NSTEMI patients were recruited from the Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH). Patients were divided into low and high- global registry of acute coronary events risk score risk score (GRS) groups based on 140. Both groups were then categorized into VEIS and DIS. Clinical outcomes, including all-cause death (ACD), cardiac death (CD), recurrent MI, and cerebrovascular accident at 12 months, were evaluated. RESULTS Among 4,733 NSTEMI patients, 62% had low GRS, and 38% had high GRS. The proportions of VEIS and DIS were 43% vs. 57% in the low GRS group and 47% vs. 53% in the high GRS group. In the low GRS group, VEIS and DIS demonstrated similar outcomes; however, in the high GRS group, VEIS exhibited worse ACD outcomes compared to DIS (HR = 1.46, P = 0.003). The adverse effect of VEIS was consistent with propensity score matched analysis (HR = 1.34, P = 0.042). CONCLUSION VEIS yielded worse outcomes than DIS in high-risk NSTEMI patients without hemodynamic instability in real-world practice.
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Affiliation(s)
- Seung Do Lee
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Rock Bum Kim
- Department of Preventive Medicine and Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Chang-Ok Seo
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Moojun Kim
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Hyo Jin Lee
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Hangyul Kim
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Hye Ree Kim
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Kyehwan Kim
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Min Gyu Kang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jeong Rang Park
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Suk Jae Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jin Yong Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Myung Ho Jeong
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Seung-Ho Hur
- Keimyung University Dongsan Medical Center, Cardiovascular Medicine, Deagu, Republic of Korea
| | - Kwang Soo Cha
- Pusan National University Hospital, Busan, South Korea
| | - Jin-Sin Koh
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
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Shin MA, Oh S, Kim MC, Sim DS, Hong YJ, Kim JH, Ahn Y, Jeong MH. Time to presentation and mortality outcomes among patients with diabetes and acute myocardial infarction. Korean J Intern Med 2024; 39:110-122. [PMID: 38086620 PMCID: PMC10790041 DOI: 10.3904/kjim.2023.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/04/2023] [Accepted: 09/25/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND/AIMS Due to limited real-world evidence on the association between time to presentation (T2P) and outcomes following acute myocardial infarction and diabetes (AMI-DM), we investigated the characteristics of patients with AMI-DM and their outcomes based on their T2P. METHODS 4,455 patients with AMI-DM from a Korean nationwide observational cohort (2011-2015) were divided into early and late presenters according to symptom-to-door time. The effects of T2P on three-year all-cause mortality were estimated using inverse probability of treatment weighting (IPTW) and survival analysis. RESULTS The incidence of all-cause mortality was consistently higher in late presenters than in early presenters (11.4 vs. 17.2%; p < 0.001). In the IPTW-adjusted dataset, the incidence of all-cause mortality was numerically higher in late presenters than in early presenters (9.1 vs. 12.4%; p = 0.072). In the survival analysis, the cumulative incidence of all-cause mortality was significantly higher in late presenters than in early presenters before and after IPTW. In the subgroup with ST-elevation myocardial infarction, late presenters had a higher incidence of cardiac death than early presenters before (4.8 vs. 10.5%; p < 0.001) and after IPTW (4.2 vs. 9.7%; p = 0.034). In the initial glycated hemoglobin (HbA1c)-stratified analysis, these effects were attenuated in patients with HbA1c ≥ 9.0% before (adjusted hazard ratio [HR]: 1.45, 95% confidence interval [CI]: 0.80-2.64) and after IPTW (adjusted HR: 0.82, 95% CI: 0.40-1.67). CONCLUSION Late presentation was associated with higher mortality in patients with AMI-DM; therefore, multifaceted and systematic interventions are needed to decrease pre-hospital delays.
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Affiliation(s)
- Min-A Shin
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- The Cardiovascular Convergence Research Center Nominated by Korea Ministry for Health and Welfare, Gwangju,
Korea
| | - Seok Oh
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- The Cardiovascular Convergence Research Center Nominated by Korea Ministry for Health and Welfare, Gwangju,
Korea
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- The Cardiovascular Convergence Research Center Nominated by Korea Ministry for Health and Welfare, Gwangju,
Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju,
Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- The Cardiovascular Convergence Research Center Nominated by Korea Ministry for Health and Welfare, Gwangju,
Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju,
Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- The Cardiovascular Convergence Research Center Nominated by Korea Ministry for Health and Welfare, Gwangju,
Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju,
Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- The Cardiovascular Convergence Research Center Nominated by Korea Ministry for Health and Welfare, Gwangju,
Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju,
Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- The Cardiovascular Convergence Research Center Nominated by Korea Ministry for Health and Welfare, Gwangju,
Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju,
Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- The Cardiovascular Convergence Research Center Nominated by Korea Ministry for Health and Welfare, Gwangju,
Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju,
Korea
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