Impact of Delay to Angioplasty on ACS Patients Studied

April 6, 2010—Paul Sorajja, MD, et al have published an analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial that aimed to determine the impact of delay to angioplasty on patients with acute coronary syndromes. The findings were published in the Journal of the American College of Cardiology (2010;55:1416–1424).

The investigators noted that there is a paucity of data on the impact of delays to percutaneous coronary intervention (PCI) on patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS) undergoing an invasive management strategy.This large-scale study demonstrated that delaying revascularization with PCI > 24 hours in patients with NSTE-ACS was an independent predictor of early and late mortality and adverse ischemic outcomes. These findings suggest that urgent angiography and triage to revascularization should be a priority in NSTE-ACS patients, the investigators concluded.

In this analysis, the investigators stratified patients undergoing PCI in the ACUITY trial according to the timing of PCI after clinical presentation for outcome analysis. PCI was performed in 7,749 patients (median age, 63 y; 73% men) with NSTE-ACS at a median of 19.5 hours after presentation (< 8 h [n = 2,197], 8–24 h [n = 2,740], and > 24 h [n = 2,812]).

The investigators found that delay to PCI > 24 hours after clinical presentation was significantly associated with increased 30-day mortality, myocardial infarction, and composite ischemia (death, myocardial infarction, and unplanned revascularization). By multivariable analysis, delay to PCI of > 24 hours was a significant independent predictor of 30-day and 1-year mortality. The incremental risk of death attributable to PCI delay > 24 hours was greatest in patients presenting with high-risk features.