Early versus Delayed Intervention in NSTEMI Patients: Impact on Clinical Outcomes, Major Adverse Cardiovascular Events, and Mortality

doi:N/A

Bangaldesh Journal of Cardivascular Medicine

2024, Volume 2, Issue 2 : 1-6

Research Article

Early versus Delayed Intervention in NSTEMI Patients: Impact on Clinical Outcomes, Major Adverse Cardiovascular Events, and Mortality

Mohammad A. Rahman

Priya K. Sharma

Ravi Perera

Ahmed S. Hossain

⁴

Department of Interventional Cardiology, Bangladesh Institute of Cardiovascular Sciences, Dhaka, Bangladesh

Department of Cardiology, National Heart Research Centre, New Delhi, India

Department of Cardiovascular Medicine, Colombo Heart Institute, Colombo, Sri Lanka

⁴

Department of Internal Medicine and Cardiology Research, South Asian Medical University, Chattogram, Bangladesh

Abstract

Background

Non-ST-Elevation Myocardial Infarction (NSTEMI) accounts for a substantial proportion of acute coronary syndrome (ACS) admissions worldwide. While invasive coronary angiography followed by revascularization remains a cornerstone of NSTEMI management, the optimal timing of intervention remains controversial, particularly in resource-limited settings.

Objective

To compare clinical outcomes of early invasive intervention (<24 hours) versus delayed invasive intervention (24–72 hours) in patients presenting with NSTEMI.

Methods

A prospective multicenter observational study was conducted among 1,620 NSTEMI patients admitted to eight tertiary cardiovascular centers across South Asia between January 2021 and December 2024. Patients were categorized into an Early Intervention Group (n=840) and a Delayed Intervention Group (n=780). Clinical outcomes including mortality, recurrent myocardial infarction, heart failure, stroke, repeat revascularization, and major adverse cardiovascular events (MACE) were analyzed over a 30-day follow-up period.

Results

The early intervention group demonstrated significantly lower rates of recurrent myocardial infarction (3.1% vs. 6.7%, p<0.001), heart failure (5.4% vs. 9.2%, p=0.002), and MACE (10.1% vs. 16.8%, p<0.001). Thirty-day mortality was lower in the early intervention group (3.2% vs. 5.8%, p=0.01).

Conclusion

Early invasive intervention in NSTEMI patients is associated with improved clinical outcomes, reduced recurrent ischemic events, and lower short-term mortality. These findings support guideline-recommended early invasive strategies, particularly among high-risk patients.

Keywords

NSTEMI

Acute Coronary Syndrome

Early Intervention

Delayed Intervention

Coronary Angiography

PCI

MACE

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