title: Long-term outcomes based on time-to-angioplasty in patients admitted with non-ST-segment elevation acute coronary syndromes.
abstract: OBJECTIVE
  We investigated the impact of the duration from hospital admission to coronary angiography on the outcome of patients admitted with non ST-segment elevation acute coronary syndromes (NSTE-ACS).
  
  
  BACKGROUND
  Invasive risk stratification in patients with acute coronary syndromes (ACS) has been shown to improve outcome in contemporary studies. It is unclear whether early coronary angiography is better than initial medical therapy with later angiography.
  
  
  METHODS
  We performed an analysis of patients admitted to a tertiary coronary intensive care unit (CICU) with NSTE-ACS and had coronary angiography performed during the same hospitalization. Patients were categorized into three groups based on the time-to-angiography: same-day, 1 to 2 days, and > 2 days. The baseline clinical features, angiography results, 30-day, 6-month cardiovascular outcome and 3-year mortality rate were compared between the groups before and after adjusting for confounding variables.
  
  
  RESULTS
  A total of 836 fulfilled the inclusion criteria. Patients undergoing angiography > 2 days had a higher incidence of 3-vessel disease (45.7% vs. 31.7%, p < 0.001), underwent less percutaneous interventions at the time of the angiography (41.6% vs. 56.7%, p < 0.001), and more frequent coronary artery bypass surgery (9.9% vs. 15.3%, p = 0.05). Patients undergoing late invasive risk stratification (> 2 days) had increased 3-year mortality (OR 2.12, 95% CI 1.03-4.35, p = 0.04) after adjusting for confounding variables.
  
  
  CONCLUSIONS
  In patients with NSTE-ACS and no contraindication to angiography, delayed angiography of more than 2 days of presentation was associated with increased mortality at 3 years.
authors.affiliation: Interventional Cardiovascular Fellowship, Henry Ford Heart and Vascular Institute, Cardiac Cath Lab, K-2, 2799 West Grand Blvd., Detroit, MI, USA.
authors.forename: Mouaz
authors.initials: M
authors.lastname: Al-Mallah
authors.forename: Khaled
authors.initials: K
authors.lastname: Dajani
authors.forename: Michael
authors.initials: M
authors.lastname: Hudson
authors.forename: Hrishikesh
authors.initials: H
authors.lastname: Iyengar
authors.forename: Noel
authors.initials: N
authors.lastname: Gutierrez
authors.forename: W Douglas
authors.initials: WD
authors.lastname: Weaver
authors.forename: Sanjaya
authors.initials: S
authors.lastname: Khanal
mesh_terms: D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D015331:Cohort Studies; D017023:Coronary Angiography / Q000592:standards* / Q000639:trends; D001026:Coronary Artery Bypass / Q000379:methods; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D011336:Probability; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors