Background—In patients with non ST-elevation myocardial infarction (NSTEMI) and Global Registry of Acute Coronary Events (GRACE) score >140, coronary angiography (CAG) is recommended by European and American guidelines within 24h. We sought to study the association of a "very early" (i.e. ≤12h), early (12-24h) and delayed (>24h) CAG in NSTEMI with GRACE score >140 with ischemic outcomes.Methods—The Treatment of Acute coronary syndrome with Otamixaban (TAO) trial randomized patients with NSTEMI and CAG scheduled within 72h to heparin plus eptifibatide versus otamixaban. In this post hoc analysis, patients with GRACE score > 140 were categorized into 3 groups according to timing of CAG from admission (<12h, ≥12h to <24h, ≥24h). The primary ischemic outcome was the composite of all-cause death and myocardial infarction (MI) within 180 days of randomization.Results—CAG was performed in 4,071 patients (<12h n=1648 (40.5%), 12-24h n=1420 (34.9%), ≥24h n=1003 (24.6%)). With CAG ≥24h as a reference, CAG from 12 to 24 hours was not associated with a lower risk of primary ischemic outcome at 180 days (odds ratio (OR) 0.96, 95% confidence interval (CI) 0.75-1.23), whereas CAG <12h was associated with a lower risk of death and MI (OR 0.71, 95% CI 0.55-0.91). Performing CAG <12h was also associated with a lower risk of death and MI (OR 0.76, 95%IC 0.61-0.94; p=0.01) compared to CAG performed 12-24h. No difference was observed regarding bleeding complications.Conclusions—In patients with high-risk NSTEMI, undergoing CAG within the initial 12 hours after admission (as opposed to later, either 12 to 24 h or ≥24 h) was associated with lower risk of ischemic outcomes at 180 days.

背景—对于非ST抬高型心肌梗死（NSTEMI）和急性冠脉事件全球登记表（GRACE）得分> 140的患者，欧洲和美国指南建议在24小时内进行冠状动脉造影（CAG）。我们试图研究NSTEMI中“非常早”（即≤12h），早期（12-24h）和延迟（> 24h）CAG与GRACE评分> 140与缺血性结局的关系。方法-使用Otamixaban（TAO）试验治疗急性冠状动脉综合征的患者，随机安排NSTEMI和CAG患者在72小时内接受肝素加eptifibatide与otamixaban的治疗。在此事后分析中，根据入院时CAG的时间（<12h，≥12h到<24h，≥24h），将GRACE得分> 140的患者分为3组。最初的缺血性结局是随机分组后180天内全因死亡和心肌梗死（MI）的综合结果。结果-在4,071名患者中进行了CAG（<12h n = 1648（40.5％），12-24h n = 1420（34.9％），≥24hn = 1003（24.6％））。以CAG≥24h为参考，在180天时12至24小时的CAG与较低的原发性缺血预后风险没有相关性（优势比（OR）为0.96，95％置信区间（CI）为0.75-1.23），而CAG <12h与较低的死亡和MI风险相关（OR 0.71，95％CI 0.55-0.91）。与进行12-24小时的CAG相比，进行CAG <12h的患者也具有较低的死亡和心梗风险（OR 0.76，95％IC 0.61-0.94; p = 0.01）。在出血并发症方面未观察到差异。结论—在高危NSTEMI患者中，入院后最初12小时内接受CAG治疗（相对于随后的12至24 h或≥24 h），在180天时缺血预后的风险较低。