Impact of Delay to Angioplasty in Patients With Acute Coronary Syndromes Undergoing Invasive Management: Analysis From the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) Trial

Objectives: The aim of this study was to determine the impact of delay to angioplasty in patients with acute coronary syndromes (ACS). Background: There is a paucity of data on the impact of delays to percutaneous coronary intervention (PCI) in patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS) undergoing an invasive management strategy. Methods: Patients undergoing PCI in the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) trial were stratified according to timing of PCI after clinical presentation for outcome analysis. Results: Percutaneous coronary intervention was performed in 7,749 patients (median age 63 years; 73% male) with NSTE-ACS at a median of 19.5 h after presentation (<8 h [n = 2,197], 8 to 24 h [n = 2,740], and >24 h [n = 2,812]). Delay to PCI >24 h after clinical presentation was significantly associated with increased 30-day mortality, myocardial infarction (MI), and composite ischemia (death, MI, and unplanned revascularization). By multivariable analysis, delay to PCI of >24 h was a significant independent predictor of 30-day and 1-year mortality. The incremental risk of death attributable to PCI delay >24 h was greatest in those patients presenting with high-risk features. Conclusions: In this large-scale study, delaying revascularization with PCI >24 h in patients with NSTE-ACS was an independent predictor of early and late mortality and adverse ischemic outcomes. These findings suggest that urgent angiography and triage to revascularization should be a priority in NSTE-ACS patients. [Copyright &y& Elsevier]