Effect of intervention timing on one-year mortality in elderly non–ST-segment elevation myocardial infarction patients
Background
The best timing for early invasive therapy in non–ST-segment elevation myocardial infarction (NSTEMI) patients remains controversial. We sought to determine the optimal timing of early catheterization in order to improve long-term outcomes in elderly (>65 years old) patients with NSTEMI.
Methods
Using data from the CRUSADE registry linked to Medicare claims, we evaluated the association of early catheterization within the first 24 h or earlier time cut-points of NSTEMI presentation with long-term mortality among older Medicare beneficiaries.
Results
Of 15 575 NSTEMI patients from 398 CRUSADE hospitals (2003–2006), 3880 (24.9%) received early (≤12 h) catheterization. Compared with those undergoing later catheterization, patients treated early were younger and had less comorbid illness. Relative to those treated later, patients receiving early catheterization had similar 1-year all-cause mortality (11.8% vs 11.9%, P = 0.90). Using on- vs off-hour presentation as an instrumental variable, balancing potential measured and unmeasured confounders, early and later catheterization patients had nonsignificant differences in 1-year mortality (+5.6% [−11.5%, +22.7%]). Similar results were observed in clinically relevant subgroups, such as age (
Source: Coronary Artery Disease - Category: Cardiology Tags: Acute Coronary Syndromes Source Type: research