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30-03-2010 | Cardiology | Article

ACUITY analysis shows delaying PCI increases mortality risk

Abstract

Free abstract

MedWire News: A post-hoc analysis of the ACUITY trial demonstrates that delaying angioplasty in patients with acute coronary syndrome (ACS) increases their risk for myocardial infarction (MI) and death.

The study found that patients in whom PCI was delayed more than 24 hours after presentation had a two-fold increase in 30-day and 50% increase in 1-year mortality compared with those treated earlier.

Patients undergoing PCI in the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) trial were stratified according to timing of PCI after clinical presentation into three groups: <8 hours; 8–24 hours; and >24 hours.

Gregg Stone (Columbia University, New York, USA) and colleagues report in the Journal of the American College of Cardiology that PCI was performed in a total of 7749 patients with non-ST-segment elevation ACS, within 8 hours after presentation in 2197 patients, at 8–24 hours in 2740, and at >24 hours in 2812 patients.

Patients who underwent PCI >24 hours after clinical presentation had significantly higher rates of death (1.7% vs 0.8% and 0.5%, p<0.0001), MI (8.0% vs 4.9% and 5.6%, p<0.0001), and composite ischemia (death, MI, and unplanned revascularization; 6.8% vs 6.2% and 4.8%, p=0.001) at 30 days than those who underwent PCI <8 hours or 8–24 hours after clinical presentation, respectively.

The increase in mortality and death or MI combined in patients undergoing PCI >24 hours after presentation persisted at 1 year of follow-up.

After multivariable adjustment for differences in baseline characteristics, a delay in PCI >24 hours after clinical presentation was independently associated with both death and the combined end point of death or MI at 30 days and 1 year, with hazard ratios of 2.14 and 1.57, respectively.

The incremental risk for death attributable to PCI delay >24 h was greatest in those patients presenting with high-risk features, the authors note.

David Antoniucci (Careggi Hospital, Florence, Italy) commented in an accompanying editorial: “Refined adjunctive antithrombotic therapies and, eventually, thrombectomy devices overcome the potential hazard of early PCI in ACS patients.

“ACS patients, particularly those with positive troponins and/or dynamic electrocardiographic changes, should be immediately triaged to catheterization laboratory-based diagnosis and treatment.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Caroline Price

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