Early Versus Delayed Percutaneous Coronary Intervention in Patients With NSTEMI and Stable Heart Failure.
Abstract
Background
Early percutaneous coronary intervention (PCI) has been shown to improve outcomes in certain high-risk patients with non-ST-segment elevation myocardial infarction (NSTEMI), but its optimal timing in those with stable heart failure (HF) remains unclear.
Aim
We aimed to compared 1 month and 1 year cardiovascular outcomes between early (< 24 h) and delayed (≥ 24 h) PCI in patients with NSTEMI with stable HF.
Methods
We identified adults with both NSTEMI and HF in TriNetX, then divided them based on PCI timing. We excluded patients with decompensated HF, STEMI, or pregnancy. Cohorts were then balanced using propensity-score matching, with standardized mean difference < 0.1. Our primary outcome was a composite of all-cause mortality, HF exacerbation, recurrent myocardial infarction (MI), and ventricular tachycardia/fibrillation (VT/VF). Secondary outcomes included individual primary outcome components, acute kidney injury, and major bleeding. Outcomes were assessed at 1 month and 1 year, expressed as relative risks (RR) with 95% confidence intervals (CI).
Results
After matching, we included 2249 patients in each cohort. After PSM, the mean age of the early PCI cohort was 69.3 ± 11.5 years, while that of the delayed PCI cohort was 69.2 ± 11.7 years, with 35% women. Hypertension (84.8%), hyperlipidemia (67.2%), and diabetes mellitus (53.1%) were the most prevalent comorbidities. Patients included both HF with preserved and reduced ejection fraction (HFpEF and HFrEF). Early PCI was associated with a higher risk of the primary outcome at both 1 month (RR = 1.23, 95% CI: 1.15-1.31, p < 0.01) and 1 year (RR = 1.12, 95% CI: 1.07-1.18, p < 0.01), compared with delayed PCI. Early PCI was associated with higher risk of recurrent MI at both time points, while risk of all-cause mortality and VT/VF were similar. Risk of HF exacerbation was higher with early PCI at 1 month but was comparable at 1 year.
Conclusion
In patients with NSTEMI and stable HF, early PCI was associated with higher risk of adverse cardiovascular outcomes, warranting further investigation in this understudied subgroup.