Iranian Heart Journal

Iranian Heart Journal

Immediate vs Standard Percutaneous Coronary Intervention Timing in Patients Presenting With Non–ST-Segment Elevation Myocardial Infarction

Document Type : Original Article

Authors
Ahmed Nabih Awad Abdelrazik Hawass
Ahmed Abdelrahman Sharaf Eldin
Ahmed Fathy Tamara
Abd El Rahman Elsayed Attia
Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Abstract
Background: The optimal timing for percutaneous coronary intervention (PCI) in patients with non–ST-segment elevation myocardial infarction (NSTEMI) remains a matter of clinical debate, particularly in high-risk but stable patients. This study aimed to evaluate whether immediate PCI (within the timeframe of primary PCI) improves clinical outcomes compared with standard early PCI (within 24 hours) in high-risk NSTEMI patients.
 
Methods: This prospective, single-center, randomized study included 300 high-risk NSTEMI patients at Ain Shams University hospitals. Patients were randomized to either immediate PCI (n = 150) or standard PCI (n = 150). Baseline characteristics, electrocardiographic (ECG) findings, echocardiographic findings, coronary angiography results, length of hospital stay, and 1- and 6-month major adverse cardiovascular events (MACE) were assessed.
 
Results: Time to angiography was significantly shorter in the immediate PCI group (1.493 ± 0.288 h vs 13.200 ± 4.780 h; P < 0.001). Hospital stay was significantly reduced in the immediate PCI group (1.447 ± 0.651 vs 2.293 ± 0.765 d; P < 0.001). No significant differences were observed in ECG findings, ejection fraction, infarct-related artery occlusion rates, or vessel distribution (P > 0.05). At 1 month, MACE occurred in 5.33% vs 7.33% (P = 0.477); at 6 months, in 11.33% vs 18.67% (P = 0.075) in immediate vs standard PCI groups, respectively.
 
Conclusions: Immediate PCI does not reduce short- or mid-term MACE compared with standard PCI, but it is associated with a significantly shorter hospital stay, supporting its role in optimizing healthcare efficiency. (Iranian Heart Journal 2026; 27(2): 38-46)
Keywords
PCI
invasive strategy timing
MACE
hospital stay
GRACE score
1.         Nowbar AN, Gitto M, Howard JP, Francis DP, Al-Lamee R. Mortality From Ischemic Heart Disease. Circ Cardiovasc Qual Outcomes. Jun 2019; 12(6):e005375. doi:10.1161/circoutcomes.118.005375
2.         Khan MA, Hashim MJ, Mustafa H, et al. Global Epidemiology of Ischemic Heart Disease: Results from the Global Burden of Disease Study. Cureus. Jul 23 2020; 12(7):e9349. doi:10.7759/cureus.9349
3.         Collet JP, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. Apr 7 2021; 42(14):1289-1367. doi:10.1093/eurheartj/ehaa575
4.         Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. Dec 23 2014; 64(24):e139-e228. doi:10.1016/j.jacc.2014.09.017
5.         Mehta SR, Cannon CP, Fox KA, et al. Routine vs selective invasive strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials. Jama. 2005; 293(23):2908-2917.
6.         Fox KA, Clayton TC, Damman P, et al. Long-term outcome of a routine versus selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome a meta-analysis of individual patient data. J Am Coll Cardiol. Jun 1 2010; 55(22):2435-45. doi:10.1016/j.jacc.2010.03.007
7.         Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. Oct 12 2023; 44(38):3720-3826. doi:10.1093/eurheartj/ehad191
8.         Thygesen K. 'Ten Commandments' for the Fourth Universal Definition of Myocardial Infarction 2018. Eur Heart J. Jan 14 2019; 40(3):226. doi:10.1093/eurheartj/ehy856
9.         Bawamia B, Mehran R, Qiu W, Kunadian V. Risk scores in acute coronary syndrome and percutaneous coronary intervention: a review. Am Heart J. 2013; 165(4):441-450.
10.      E Backus B, J Six A, H Kelder J, B Gibler W, L Moll F, A Doevendans P. Risk scores for patients with chest pain: evaluation in the emergency department. Curr Cardiol Rev. 2011; 7(1):2-8.
11.      Lebeau R, Serri K, Lorenzo MD, et al. Assessment of LVEF using a new 16-segment wall motion score in echocardiography. Echo Res Pract. Jun 2018; 5(2):63-69. doi:10.1530/erp-18-0006
12.      Kesieme EB, Iruolagbe CO, Omoregbee BI, Inuwa IM. Basic Overview of Conventional Coronary Angiography for Planning Cardiac Surgery. Cureus. Jan 2024; 16(1):e52942. doi:10.7759/cureus.52942
13.      De Luca G, Suryapranata H, Stone GW, et al. Coronary stenting versus balloon angioplasty for acute myocardial infarction: a meta-regression analysis of randomized trials. Int J Cardiol. May 7 2008; 126(1):37-44. doi:10.1016/j.ijcard.2007.03.112
14.      Zheng JJ, Si YQ, Xia TY, Lu BJ, Zeng CY, Wang WE. Optimal timing of invasive intervention for high-risk non-ST-segment-elevation myocardial infarction patients. J Geriatr Cardiol. Aug 28 2024; 21(8):807-815. doi:10.26599/1671-5411.2024.08.003
15.      Kite TA, Ladwiniec A, Greenwood JP, et al. Very early invasive strategy in higher risk non-ST-elevation acute coronary syndrome: the RAPID NSTEMI trial. Heart. 2024; 110(7):500-507.
16.      Kofoed KF, Kelbæk H, Hansen PR, et al. Early Versus Standard Care Invasive Examination and Treatment of Patients With Non-ST-Segment Elevation Acute Coronary Syndrome. Circulation. Dec 11 2018; 138(24):2741-2750. doi:10.1161/circulationaha.118.037152
17.      Milosevic A, Vasiljevic-Pokrajcic Z, Milasinovic D, et al. Immediate Versus Delayed Invasive Intervention for Non-STEMI Patients: The RIDDLE-NSTEMI Study. JACC Cardiovasc Interv. Mar 28 2016;9(6):541-9. doi:10.1016/j.jcin.2015.11.018
18.      Milasinovic D, Milosevic A, Marinkovic J, et al. Timing of invasive strategy in NSTE-ACS patients and effect on clinical outcomes: a systematic review and meta-analysis of randomized controlled trials. Atherosclerosis. 2015; 241(1):48-54.
19.      Khan AR, Golwala H, Tripathi A, et al. Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: a systematic review and meta-analysis. Eur Heart J. Nov 1 2017; 38(41):3082-3089. doi:10.1093/eurheartj/ehx418
Iranian Heart Journal
Volume 27, Issue 2
Spring 2026
Pages 38-46