TITLE

Immediate versus deferred coronary angioplasty in non-ST-segment elevation acute coronary syndromes

AUTHOR(S)
Riezebos, R K; Ronner, E; ter Bals, E; Slagboom, T; Smits, P C; ten Berg, J M; Kiemeneij, F; Amoroso, G; Patterson, M S; Suttorp, M J; Tijssen, J G P; Laarman, G J
PUB. DATE
May 2009
SOURCE
Heart;May2009, Vol. 95 Issue 10, p807
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: The field of acute coronary syndromes is characterised by an increasing tendency towards early invasive catheter-based diagnostics and therapeutics—a practice based on observational and retrospective data. Objective: To compare immediate versus deferred angioplasty in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) Methods: A randomised, prospective multicentre trial was performed in patients admitted with NSTE-ACS, eligible for percutaneous coronary intervention (PCI). Interim analysis was performed after enrolment of 251 patients; PCI was appropriate in 142 patients. These patients were randomised to immediate PCI (n = 73) or deferred PCI (24–48 h) (n = 69). Patients received protocol-driven glycoprotein IIb/IIIa blockers, aspirin and clopidogrel. The primary end point was a composite of death, non-fatal myocardial infarction (MI) or unplanned revascularisation, at 30 days. After hospital discharge outpatient follow-up was performed at 30 days and 6 months. Results: The incidence at 30 days of the primary end point was 60% in the group receiving immediate PCI and 39% in the group receiving deferred PCI (relative risk (RR) = 1.5, 95% CI 1.09 to 2.15; p = 0.004). No deaths occurred in either group. MI was significantly more common in the group receiving immediate PCI (60% vs 38%, RR = 1.6, 95% CI 1.12 to 2.28, p = 0.005). Unplanned revascularisation was similar in both groups. The observed difference was preserved over 6-months’ follow-up. Conclusions: Immediate PCI was associated with an increased rate of MI in comparison with a 24–48 h deferred strategy, despite aggressive antithrombotic treatment. The results suggest that PCI for high-risk patients with non-refractory NSTE-ACS should be delayed for at least 24 h after hospital admission. Trial registration number: ISRCTN80874637
ACCESSION #
66094659

 

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