We know that cath is beneficial in patients with NSTEMI, but the timing of the intervention is not known. In this RCT of >3000 patients with NSTEMI, they were randomized to early cath (<24 hours, actual mean timing 14 hours) or delayed cath (>36 hours, actual mean timing 50 hours). There was no difference in the primary outcome measure (composite death, MI, CVA at 6 months). However, in subgroup analysis, those at the highest risk (as defined by the GRACE score, abstract), did have better outcomes in the early intervention (abstract). In general, most NSTEMI patients will do just as well with early or delayed cath, other than those at highest GRACE risk score (risk factors including age, CHF, PVD, SBP, creatinine, killip class, cardiac arrest, ST deviation, and elevated biomarkers).
Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.