title: Timing of percutaneous coronary intervention in troponin-negative patients with acute coronary syndrome without persistent ST-segment elevation: preliminary results and status quo in German chest pain units.
abstract: OBJECTIVE
  Management of acute coronary syndromes without persistent ST-segment elevation (NSTE-ACS) and unstable angina pectoris (UAP) remains challenging. The study aimed to analyze the current management of UAP patients in German chest pain units focussing on the different time lines of invasive strategy.
  
  
  METHODS
  A total of 1400 UAP patients admitted to a certified chest pain unit were enrolled. Analyses of high-risk criteria with indication for invasive management and of 3-month clinical outcomes were performed by subgrouping UAP patients to immediate and early invasive (<8 hours), early elective invasive (8-24 hours), late elective invasive (24-72 hours) strategy, and without percutaneous coronary intervention (PCI).
  
  
  RESULTS
  Coronary angiography was performed in 60.6% of the UAP patients, whereas PCI was necessary in 37%. Only 1.4% of the UAP patients obtained immediate PCI within the first 120 minutes. In 16.9%, patients received PCI within the first day of hospitalization or even within the first 8 hours after admission in another 7.7%, although the Global Registry of Acute Coronary Events (GRACE) score at admission was below 140. In the remaining 12.4% of the UAP patients, PCI was performed within 24-72 hours after admission. Those patients exhibited a higher prevalence of secondary risk markers than those with conservative treatment regimen.
  
  
  CONCLUSIONS
  To date, almost two-third of UAP patients at intermediate to high risk receive rapid invasive regimen within the first 24 hours after admission. Oncoming studies will have to analyze its overall guideline-adherence and resulting differences in major adverse events.
authors: From the *Department of Cardiology, Arnsberg Medical Center, Arnsberg; †Institute for Myocardial Infarction Research Foundation Ludwigshafen, University of Heidelberg, Heidelberg; ‡2nd Department of Medicine, Johannes Gutenberg-University Mainz, Mainz; §3rd Department of Medicine, University Hospital Heidelberg, Heidelberg; and ¶Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany.
authors: Frank
authors: F
authors: Breuckmann
authors: Matthias
authors: M
authors: Hochadel
authors: Thomas
authors: T
authors: Münzel
authors: Evangelos
authors: E
authors: Giannitsis
authors: Thomas
authors: T
authors: Voigtländer
authors: Jochen
authors: J
authors: Senges
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000150:complications / Q000601:surgery*; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D017023:Coronary Angiography; D003325:Coronary Care Units / Q000706:statistics & numerical data*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010343:Patient Admission / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood*
chemical_list: D014336:Troponin