Intraoperative safety analysis and impact on short-to mid-term prognosis of the emergency coronary interventions in patients with high-risk non-ST-segment elevation myocardial infarction

Hou Yiyong; Xie Chunqiao

Abstract：Objective To observe the intraoperative safety and short-to mid-term clinical outcomes of emergency coronary intervention in patients with non-ST-segment elevation myocardial infarction(NSTEMI)with high risk assessment,and to provide clinical theoretical basis for the timing of intervention in high-risk NSTEMI patients.Methods Retrospective analysis was conducted in 108 patients with NSTEMI within 24 hours of onset,with GRACE scores>140 and at high risk for percutaneous coronary intervention(PCI),who were first seen at Nanjing Tongren Hospital,School of Medicine,Southeast University,between June 2020 and May 2022.58 patients who underwent emergency(within 2 hours)PCI after consultation were designated as the observation group,and 50 patients who underwent routine(within 2-24 hours)PCI after consultation were designated as the control group.For PCI operation,the two groups were compared in duration of intervention,radiation dose,intraoperative contrast dosage and occurrence of intraoperative complications,for example,slow flow/no reflow,severe bleeding,acute left heart failure,acute pericardial tamponade,cardiogenic shock and death.During hospital stay and 12-month follow-up after PCI,the two groups were compared for major adverse cardiovascular and cerebrovascular events(MACCE),including recurrent angina pectoris,re-hospitalisation for heart failure,recurrent non-fatal myocardial infarction,target vessel revascularisation,stroke and cardiogenic death.Results There were 14 intraoperative complications in the observation group and 10 in the control group,with no statistically significant difference(20.14%vs 16.00%,χ2=0.391,P=0.606).During hospitalization 9 MACCE events occurred in the observation group and 9 in the control group with a statistically insignificant difference(15.52%vs 18.00%,χ2=0.119,P=0.730).The number of cumulative MACCE events 12 months after operation was 9 in the observation group and 17 in the control group,with a statistically significant difference(15.52%vs 34.00%,χ2=5.018,P=0.025).Conclusion Emergency PCI in patients with high-risk NSTEMI is safe and feasible and may improve the medium-term prognosis of patients.