biostudies-literatureUnknown18(7)Eggers KM<h4>Background</h4>Current guidelines stress the importance of early invasive assessment of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), in particular those at high risk. However, supporting scientific evidence is limited.<h4>Aims</h4>We aimed to investigate the prognostic impact of the timing of coronary angiography in a large cohort of NSTE-ACS patients.<h4>Methods</h4>We performed a retrospective analysis including 34,666 NSTE-ACS patients registered from 2013 to 2018 in the SWEDEHEART registry. The prognostic implications of the timing of coronary angiography on a continuous scale and within <24 vs 24-72 hours were assessed using Cox regression analyses.<h4>Results</h4>The median time interval from admission to invasive assessment was 32.8 (25th, 75th percentiles 20.4-63.8) hours. There was no apparent time window within 96 hours from admission that provided prognostic benefit. Coronary angiography within 24-72 hours (vs <24 hours) was not associated with worse outcome overall (all-cause mortality: hazard ratio 1.01, 95% confidence interval [CI] 0.92-1.11; major adverse events: hazard ratio 1.04, 95% CI: 0.98-1.12). Interaction analyses indicated a greater relative benefit of coronary angiography <24 hours in some lower-risk groups (women, non-diabetics, patients with minor troponin elevation) but neutral effects in higher-risk groups (defined by age or the GRACE 2.0 score).<h4>Conclusions</h4>These Swedish data do not provide support for an early invasive strategy in NSTE-ACS, especially in high-risk patients. Our results suggest that the timing of invasive assessment should rather be based on individualised decisions integrating symptoms and risk panorama than on strictly defined time intervals.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology582-589https://www.ebi.ac.uk/biostudies/studies/S-EPMC10241271biostudies-literatureTiming of coronary angiography in patients with non-ST-elevation acute coronary syndrome: long-term clinical outcomes from the nationwide SWEDEHEART registry.PMC10241271Eggers KMLindahl BJames SKJernberg TfalseTiming of coronary angiography in patients with non-ST-elevation acute coronary syndrome: long-term clinical outcomes from the nationwide SWEDEHEART registry.<h4>Background</h4>Current guidelines stress the importance of early invasive assessment of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), in particular those at high risk. However, supporting scientific evidence is limited.<h4>Aims</h4>We aimed to investigate the prognostic impact of the timing of coronary angiography in a large cohort of NSTE-ACS patients.<h4>Methods</h4>We performed a retrospective analysis including 34,666 NSTE-ACS patients registered from 2013 to 2018 in the SWEDEHEART registry. The prognostic implications of the timing of coronary angiography on a continuous scale and within <24 vs 24-72 hours were assessed using Cox regression analyses.<h4>Results</h4>The median time interval from admission to invasive assessment was 32.8 (25th, 75th percentiles 20.4-63.8) hours. There was no apparent time window within 96 hours from admission that provided prognostic benefit. Coronary angiography within 24-72 hours (vs <24 hours) was not associated with worse outcome overall (all-cause mortality: hazard ratio 1.01, 95% confidence interval [CI] 0.92-1.11; major adverse events: hazard ratio 1.04, 95% CI: 0.98-1.12). Interaction analyses indicated a greater relative benefit of coronary angiography <24 hours in some lower-risk groups (women, non-diabetics, patients with minor troponin elevation) but neutral effects in higher-risk groups (defined by age or the GRACE 2.0 score).<h4>Conclusions</h4>These Swedish data do not provide support for an early invasive strategy in NSTE-ACS, especially in high-risk patients. Our results suggest that the timing of invasive assessment should rather be based on individualised decisions integrating symptoms and risk panorama than on strictly defined time intervals.2022-01-01T00:00:00Z2022 Sep2026-05-13T14:33:09.803Z2025-04-07T10:18:29.103ZS-EPMC102412713535268110.4244/EIJ-D-21-0098210.4244/eij-d-21-00982