Impact of symptom-to-balloon time in patients with non-ST-segment elevation myocardial infarction and complex lesions

초록

Aims: Considering the limited data regarding clinical outcomes of patients with non-ST-segment on the ECG elevation myocardial infarction (NSTEMI), this study compared the outcomes of patients undergoing percutaneous coronary intervention with newer-generation drug-eluting stents stratified by the presence/absence of complex lesions and symptom-to-balloon time (SBT; <48 h or >= 48 h). Methods: We enrolled 4373 patients with NSTEMI from the Korea Acute Myocardial Infarction Registry-National Institute of Health dataset and stratified them into the complex group (2106 patients; SBT < 48 h, n = 1365; SBT >= 48 h, n = 741) and the noncomplex group (2267 patients; SBT < 48 h, n = 1573; SBT >= 48 h, n = 694). The primary outcome was the 3-year all-cause mortality rate. The secondary outcomes were any major adverse cardiac events (MACE), including cardiac death (CD), recurrent myocardial infarction, and stroke. Results: The incidence of all-cause mortality (adjusted hazard ratio, 0.656; P = 0.009), CD (P = 0.037), and MACE (P = 0.047) in the complex group and of stroke in the noncomplex group (P = 0.020) were significantly lower in patients with SBT < 48 h than in those with SBT >= 48 h. Among patients with SBT < 48 h, the stroke incidence (P = 0.019) was higher in the complex group than in the noncomplex group, while among patients with SBT >= 48 h, the MACE incidence (P = 0.011) was higher in the former than in the latter. Conclusion: SBT reduction effectively decreased the 3-year mortality in patients with NSTEMI in the complex group compared with the noncomplex group.

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