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Background In patients presenting with non ST-segment elevation acute coronary syndromes (NSTE-ACS) an invasive approach has been shown to be superior to conservative management. Purpose We aimed to investigate the optimal timing of invasive coronary angiography and subsequent intervention. Methods We examined the impact ofearly (≤24h) versus delayed (&amp;gt;24h) intervention in a large observational cohort of 20882 consecutive patients with acute NSTE myocardial infarction (NSTEMI) treated with PCI between 2005 and 2015 at 9 tertiary cardiac centers in London (UK) using Cox-regression analysis and propensity matching. Results Mean age was 64.5±12.7 years and 26.1% were females. A quarter (27.6%), were treated within 24h.Patients treated within 24h were slightly younger (62.8±12.8 vs. 65.2±12.6, p&amp;lt;0.001), most commonly male (76% vs. 72.9%, p&amp;lt;0.001) and were more frequently ventilated (2.3% vs. 1.4%, p&amp;lt;0.001) and in cardiogenic shock (3.6% vs. 1.4%, p&amp;lt;0.001) with dynamic changes on their ECG (84.5% vs. 76.1% p&amp;lt;0.001). At a median follow up of 4.2 years (interquartile range 1.8 to 7) 17.7% of patients had died. Estimated 5-year survival in patients treated within 24h was 84.6% vs. 81% for those treated &amp;gt;24h following their presentation (p&amp;lt;0.001). This survival benefit remained following adjustment for confounders; HR (delayed vs. early management)1.11 (95% CI 1.003 to 1.23, p=0.046). In the propensity matched cohort of 4356 patients in each group, there remained a trend for higher survival in the early intervention group (p=0.061). Conclusions Notwithstanding the limitations of the retrospective design, this real-world cohort of NSTEMI patients suggests that an early intervention (≤24h) may improve mid term survival. Figure 1 Funding Acknowledgement Type of funding source: None

european heart journal

Impact of early (&amp;lt;24h) versus delayed (&amp;gt;24h) intervention in patients with non ST segment elevation myocardial infarction (an observational study of 20882 patients)