title: Impact of delay to angioplasty in patients with acute coronary syndromes undergoing invasive management: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) trial.
abstract: OBJECTIVE
  The aim of this study was to determine the impact of delay to angioplasty in patients with acute coronary syndromes (ACS).
  
  
  BACKGROUND
  There is a paucity of data on the impact of delays to percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) undergoing an invasive management strategy.
  
  
  METHODS
  Patients undergoing PCI in the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) trial were stratified according to timing of PCI after clinical presentation for outcome analysis.
  
  
  RESULTS
  Percutaneous coronary intervention was performed in 7,749 patients (median age 63 years; 73% male) with NSTE-ACS at a median of 19.5 h after presentation (<8 h [n=2,197], 8 to 24 h [n=2,740], and >24 h [n=2,812]). Delay to PCI>24 h after clinical presentation was significantly associated with increased 30-day mortality, myocardial infarction (MI), and composite ischemia (death, MI, and unplanned revascularization). By multivariable analysis, delay to PCI of >24 h was a significant independent predictor of 30-day and 1-year mortality. The incremental risk of death attributable to PCI delay>24 h was greatest in those patients presenting with high-risk features.
  
  
  CONCLUSIONS
  In this large-scale study, delaying revascularization with PCI>24 h 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.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Sorajja
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.forename: David A
authors.initials: DA
authors.lastname: Cox
authors.forename: Michael G
authors.initials: MG
authors.lastname: McLaughlin
authors.forename: Peter
authors.initials: P
authors.lastname: Zimetbaum
authors.forename: Costantino
authors.initials: C
authors.lastname: Costantini
authors.forename: Thomas
authors.initials: T
authors.lastname: Stuckey
authors.forename: James E
authors.initials: JE
authors.lastname: Tcheng
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Grines
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014218:Triage