Optimal timing of invasive intervention for high-risk non-ST-segment-elevation myocardial infarction patientsOA

OBJECTIVE To compare the immediate,early,and delayed percutaneous coronary intervention(PCI)strategies in non-ST-seg-ment-elevation myocardial infarction(NSTEMI)patients with high-risk. METHODS Medical records of patients treated at the Daping Hospital,Third Military Medical University,Chongqing,China between 2011 and 2021 were retrospectively reviewed.Only patients with complete available information were included.All pa-tients assigned into three groups based on the timing of PCI including immediate(＜2 h),early(2-24 h)and delayed(＞24 h)in-tervention.Multivariable Cox hazards regression and simpler nonlinear models were performed. RESULTS A total of 657 patients were included in the study.The median follow-up length was 3.29(interquartile range:1.45-4.85)years.Early PCI strategy improved the major adverse cardiac event(MACE)outcome compared to the immediate or delay-ed PCI strategy.Early PCI,diabetes mellitus,and left main or/and left anterior descending or/and left circumflex stenosis or/and right coronary artery ≥ 99％were predictors for MACE outcome.The optimal timing range for PCI to reduce MACE risk is 3-14 h post-admission.For high-risk NSTEMI patients,early PCI reduced primary clinical outcomes compared to immediate or delayed PCI,and the optimal timing range was 3-14 h post-admission.Delayed PCI was superior for NSTEMI with chronic kidney injury. CONCLUSIONS Delayed invasive strategy was helpful to reduce the incidence of MACE for high-risk NSTEMI with chronic kidney injury.An immediate PCI strategy might increase the rate of MACE.