Early percutaneous coronary intervention and in-hospital mortality in non st elevation coronary syndromes

Abstract

Introduction PCI timing remains controversial in patients with non ST elevation coronary syndromes. Objectives To analyze the influence of early PCI (ePCI) on in-hospital mortality in this population. Methods We analyzed 449 patients with diagnosis of non ST elevation coronary syndrome consecutively admitted in our teaching referrall ICU during the period 01/01/2012 - 20/03/2015. When PCI was performed during ICU it was considered ePCI. Otherwise (patients without PCI or with delayed PCI after ICU stay) were considered non ePCI. We analyzed the influence of ePCI in hospital mortality. An univariate analysis with in-hospital mortality as the main outcome and NYHA, Saps 3, age and sex as the main covariates was performed. A binary logistic regression was also performed to adjust for the main confounders. Chi square, T-test and binary logistic regression were used. Results A total of 296 patients were treated with ePCI. Those with ePCI had a lower mortality than those without ePCI (4.07% vs 9.15%; p 0.029). The multivariate analysis showed that the independent predictors were both Saps 3 and NYHA score. Results of both univariate and multivariate analysis are shown in Tables 1 and 2. Table 1 Univariate Analysis. ePCI patiens were younger and with lower severity scores than their counterparts without ePCI. Variable With ePCI Without ePCI p N 229 220 Age (years) 65.7 (SD 12.7) 70.4 (SD 12.0) 0.001 Female Sex (%) 21.96 32.68 0.014 Saps 3 score 44.78 (SD 7.80) 47.81 (SD 8.92) 0.001 NYHA (III) (%) 6.42 13.73 0.001 In-Hospital Mortality (%) 4.07 9.15 0.029 Table 2 Multivariate Analysis. Variable Odss Ratio 95% CI p Saps 3 score 1.13 1.08-1.18 0.001 NYHA II 2.94 0.91-9.45 0.071 NYHA III 5.88 1.45-23.84 0.013 ePCI 0.59 0.26-1.36 0.218 After multivariate analysis ePCI lost his protective effect and mortality seems to be mainly related to patient´s severity (saps 3 or NYHA score) Conclusions In our population ePCI do not determine in-hospital mortality. Severity measured either by Saps 3 or by NYHA scores, and not ePCI, seems to be the major determinant of mortality.