Early Interventional Therapy For Average Risk Acute Non-ST-Segment Elevation Myocardial Infarction Patients

ObjectiveThis study sought to assess the clinical impact of early versus delayed invasive intervention in patients with non–ST-segment myocardial infarction(NSTEMI).MethodWe randomized 224 NSTEMI patients to an early intervention group(<24 h after randomization,n = 112) and a delayed-intervention group(24 to 72 h, n =112).The primary endpoint was the occurrence of deathor new myocardial infarction(MI) at 30-day follow-up.ResultMedian time from randomization to angiography was 11.0 h and 63.0 h in the early-intervention group and the delayed-intervention group, respectively(p < 0.001). At30 days, the primary endpoint was achieved less frequently in patients undergoing early intervention(3.6% vs8.9%, hazard ratio: 0.32, 95% confidence interval:0.13 to 0.72; p=0.007). At six month, this difference persisted(8.0% in the early-intervention group vs.15.2% in delayed-intervention group; hazard ratio: 0.34, 95% confidence interval: 0.17 to0.67; p =0.002). The observed results were mainly attributable to the occurrence of new MI in the pre-catheterization period(0 deaths + 0 MIs in theearly-intervention group vs.0death +4 MIs in the delayed-intervention group). The rate of deaths, new MI, or recurrent ischemia was lower in the early-intervention group at both 30 days(7.1% vs. 15.2%; p <0.001) and six month(15.2% vs. 33.0%; p < 0.001).Conclusion early invasive strategy in NSTEMI patients is associated with lower rates of death or new MI compared with the delayed invasive strategy at early and midterm follow-up.