title: Clinical impact of immediate invasive strategy in patients with non-ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Immediate invasive approach for non-ST-segment elevation myocardial infarction (NSTEMI) may permit treatment of the underlying plaque rupture as early as possible with subsequent reduction of death and myocardial infarction (MI). We sought to assess clinical impact of immediate percutaneous coronary intervention (PCI) for NSTEMI.
  
  
  METHODS
  A total of 6134 NSTEMI patients undergoing PCI from the Korea Acute Myocardial Infarction Registry were divided into group 1 (immediate PCI within 4h, n=1132) and group 2 (non-immediate PCI after 4h, n=5002). Propensity-matched 12-month clinical outcome was compared.
  
  
  RESULTS
  In all patients and propensity-matched cohort (n=1131 in each group), group 1 had higher peak troponin level, higher rate of pre-PCI Thrombolysis In Myocardial Infarction (TIMI) grade 0 or 1, higher use of glycoprotein IIb/IIIa inhibitor, and lower use of unfractionated heparin and nitrates. In all patients, 12-month rates of MI and death/MI were higher in group 1. No differences were observed in 12-month death and major adverse cardiac events (MACE: composite of death, MI, target-vessel revascularization, and coronary artery bypass graft surgery). In propensity-matched cohort, no significant differences were observed in 12-month rates of death, MI, death/MI or MACE. However, group 1 had less major bleeding (0.8% vs. 3.0%, p=0.024) and shorter hospital stay.
  
  
  CONCLUSIONS
  Immediate PCI for patients with NSTEMI was associated with lower pre-PCI culprit vessel patency and not with improved 12-month clinical outcome.
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Doo Sun
authors.initials: DS
authors.lastname: Sim
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea. Electronic address: myungho@chollian.net.
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.affiliation: Yeungnam University Hospital, Daegu, Republic of Korea.
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Kyungpuk National University Hospital, Daegu, Republic of Korea.
authors.forename: Shung Chull
authors.initials: SC
authors.lastname: Chae
authors.affiliation: Busan National University Hospital, Busan, Republic of Korea.
authors.forename: Taek Jong
authors.initials: TJ
authors.lastname: Hong
authors.affiliation: Chungnam National University Hospital, Daejon, Republic of Korea.
authors.forename: In Whan
authors.initials: IW
authors.lastname: Seong
authors.affiliation: Chunbuk National University Hospital, Jeonju, Republic of Korea.
authors.forename: Jei Keon
authors.initials: JK
authors.lastname: Chae
authors.affiliation: Kyung Hee University Hospital, Seoul, Republic of Korea.
authors.forename: Chong Jin
authors.initials: CJ
authors.lastname: Kim
authors.affiliation: Chungbuk National University Hospital, Cheongju, Republic of Korea.
authors.forename: Myeong Chan
authors.initials: MC
authors.lastname: Cho
authors.affiliation: Korea University Guro Hospital, Seoul, Republic of Korea.
authors.forename: Seung-Woon
authors.initials: SW
authors.lastname: Rha
authors.affiliation: Konyang University Hospital, Daejon, Republic of Korea.
authors.forename: Jang Ho
authors.initials: JH
authors.lastname: Bae
authors.affiliation: Catholic University Hospital, Seoul, Republic of Korea.
authors.forename: Ki Bae
authors.initials: KB
authors.lastname: Seung
authors.affiliation: Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Seung Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000639:trends*; D057216:Propensity Score; D011446:Prospective Studies; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Bleeding; Myocardial infarction; Percutaneous coronary intervention