Timing of invasive coronary angiography, management, and in-hospital outcomes among patients with non-ST-segment elevation myocardial infarction: A comprehensive nationwide analysis

Background: The impact of timing of invasive coronary angiography (ICA) and management strategies on in-hospital outcomes among unselected all-comers with non-ST-segment elevation myocardial infarction (NSTEMI) presents an equipoise in clinical practice. Methods: Patients with NSTEMI from the US NIS database during 2016 to 2021 were included in the analysis. In-hospital outcomes were examined according to the timing of ICA - early (<24 h), intermediate (24-72 h), and delayed (>72 h). These outcomes included all-cause death, major adverse cardiovascular and cerebrovascular events (MACCE), major bleeding, reinfarctions, cardiovascular complications, and stroke. Results: A total of 4,238,570 admissions with NSTEMI were screened of which 1,811,545 (42.7 %) received ICA. Most of patients (48.9 %) received ICA during 2nd and 3rd day following admission, whereas 32.5 % and 18.6 % received early and delayed ICA, respectively. Percutaneous coronary intervention (PCI) was performed in 54.7 %, 47.8 %, and 37.1 % of cases among patients that underwent ICA <24 h, 24-72 h, and > 72 h, respectively. Patients receiving delayed ICA were more likely to be older, women, have more comorbidites and high-risk features. Compared to ICA <24 h, ICA performed at 24–72 h was associated with reduced odds of death (OR 0.80), MACCE (OR 0.85), reinfarction (OR 0.63), and cardiovascular complications (OR 0.89) with no difference concerning major bleeding and stroke. Conclusions: <50 % of patients with NSTEMI in a contemporary nationwide US cohort receive ICA while 1 in 2 patients out of those receive PCI. ICA timing at 24–72 h appears to provide the optimal safety profile with respect to primary outcomes and complications.