Timing of invasive strategy in patients with non-ST segment elevation acute myocardial infarction: A nationwide retrospective cohort analysis.

Background: The Dutch ACS working group endorses a delayed invasive approach for non-ST segment elevation myocardial infarction (NSTEMI) patients as safe and acceptable. We analysed the timing of invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI) for all patients admitted with NSTEMI.

Methods: For this retrospective observational cohort study initiated by the Netherlands Heart Registration, we extracted Dutch medical claims and diagnosis codes for all NSTEMI patients who underwent PCI. Primary outcome was the time from hospital admission to ICA and PCI in patients admitted to PCI and non-PCI centres. Secondary analyses included the time from ICA to PCI and variation among individual PCI centres.

Results: A total of 36,573 NSTEMI patients (median age 68 years, 30% female) were included in the analysis. 24,857 patients (68%) were admitted to a hospital with PCI facilities (n = 30) and 11,716 patients (32%) to a hospital without PCI on site (n = 42). ICA was performed < 3 days (72 h) in 33,476 patients (92%). For patients admitted in PCI centres ICA was performed < 3 days in 94% (n = 23,328), median 0 days (IQR 0-1) vs 87% (n = 10,148), median 1 day (IQR 1-2) in non-PCI centres. The longest delay (median 3 days; IQR 2-5) between ICA and PCI occurred in patients first admitted to non-PCI centres and transferred after local ICA.

Conclusions: ICA within three days is achieved in a very high percentage of patients in both PCI and non-PCI centres. A clearly larger percentage receives PCI within three days when directly admitted to a PCI centre.