Results of early and delayed invasive approaches in managing patients with non-ST elevation acute coronary syndrome
Tsvetkov R.S., Mironkov A.B., Pryamikov A.D.
Keywords: non-ST elevation ACS, transcatheter coronary intervention
Background. Reports on advantages of early and delayed invasive approaches in the treatment of patients with unstable angina / non-ST elevation MI are inconsistent. Aim. To compare outcomes of early and delayed approaches in the treatment of patients with non-ST elevation ACS (nSTEACS) and different GRACE risk scores. Materials and methods. 60 patients were divided into two groups: early intervention (n=30) and delayed intervention (n=30). In the early intervention group, coronary angiography (CAG) with subsequent transcutaneous coronary intervention (TCCI) was performed urgently (0.5 to 3 hours of admission); in the delayed intervention group, TCCI was performed within 2 to 7 days. Results. Early outcomes did not significantly differ between the treatment groups. In the remote period (30 days to 12 months), incidence of fatal outcome differed significantly (p=0.001) in favor of the delayed intervention. Significant differences between other indices (acute MI and angina relapse) were absent. Conclusion. Delayed CAG with subsequent endovascular revascularization is a method, which is effective and no less safe than urgent intervention for managing patients with nSTEACS whose condition cannot be stabilized with drugs.
- de Winter RJ, Windhausen F, Cornel JH et al. Early invasive versus selectively invasive management for acute coronary syndromes. N Engl J Med. 2005;353 (11):1095–1104.
- Neumann FJ, Kastrati A, Pogatsa-Murray G et al. Evaluation of prolonged antithrombotic pretreatment («cooling-off» strategy) before intervention in patients with unstable coronary syndromes: a randomized controlled trial. JAMA. 2003 Sep 24;290 (12):1593–9.
- Mehta SR, Cannon CP, Fox KA et al. Routine vs selective invasive strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials. JAMA. 2005 Jun 15;293 (23):2908–17.
- Bavry AA, Kumbhani DJ, Rassi AN et al. Benefit of early invasive therapy in acute coronary syndromes: a meta-analysis of contemporary randomized clinical trials. J Am Coll Cardiol. 2006 Oct 3;48 (7):1319–25.
- O'Donoghue M, Boden WE, Braunwald E et al. Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction: a meta-analysis. JAMA. 2008 Jul 2;300 (1):71–80.
- Cannon CP, Weintraub WS, Demopoulos LA et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb / IIIa inhibitor tirofiban. N Engl J Med. 2001 Jun 21;344 (25):1879–87.
- Effects of tissue plasminogen activator and a comparison of early invasive and conservative strategies in unstable angina and non-Q-wave myocardial infarction. Results of the TIMI IIIB Trial. Thrombolysis in Myocardial Ischemia. Circulation. 1994 Apr;89 (4):1545–56.
- Riezebos RK, Ronner E, Ter Bals E et al. Immediate versus deferred coronary angioplasty in non-ST-segment elevation acute coronary syndromes. Heart. 2009 May;95 (10):807–12.
- Fox KA, Dabbous OH, Goldberg RJ et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ. 2006;333 (7578):1091.
- Antman EM, Cohen M, Bernink PJ et al. The TIMI risk score for unstable angina / non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA. 2000;284 (7):835–842.
- Mehta SR, Granger CB, Boden WE et al. Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med. 2009 May 21;360 (21):2165–75.
- Hirsch A, Windhausen F, Tijssen JG et al. Long-term outcome after an early invasive versus selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome and elevated cardiac troponin T (the ICTUS trial): a follow-up study. Lancet. 2007 Mar 10;369 (9564):827–35.
- Damman P, Hirsch A, Windhausen F et al. 5‑year clinical outcomes in the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial a randomized comparison of an early invasive versus selective invasive management in patients with non-ST-segment elevation acute coronary syndrome. J Am Coll Cardiol. 2010 Mar 2;55 (9):858–64.
- Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC II prospective randomised multicentre study. FRagmin and Fast Revascularisation during InStability in Coronary artery disease Investigators. Lancet. 1999;354 (9180):708–715.
- Lagerqvist B, Husted S, Kontny F et al. 5‑year outcomes in the FRISC–II randomised trial of an invasive versus a non-invasive strategy in non-ST-elevation acute coronary syndrome: a follow-up study. Lancet. 2006 Sep 16;368 (9540):998–1004.
- Fox KA, Poole-Wilson PA, Henderson RA et al. Interventional versus conservative treatment for patients with unstable angina or non-ST-elevation myocardial infarction: the British Heart Foundation RITA 3 randomised trial. Randomized Intervention Trial of unstable Angina. Lancet. 2002 Sep 7;360 (9335):743–51.
- Fox KA, Poole-Wilson P, Clayton TC et al. 5‑year outcome of an interventional strategy in non-ST-elevation acute coronary syndrome: the British Heart Foundation RITA 3 randomised trial. Lancet. 2005 Sep 10–16;366 (9489):914–20.
- Badings EA, The SH, Dambrink JH et al. Early or late intervention in high-risk non-ST-elevation acute coronary syndromes: results of the ELISA-3 trial. EuroIntervention. 2013 May 20;9 (1):54–61.
- Hoffmann U, Bamberg F, Chae CU et al. Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) trial. J Am Coll Cardiol. 2009 May 5;53 (18):1642–50.
- Rubinshtein R, Halon DA, Gaspar T et al. Usefulness of 64‑slice cardiac computed tomographic angiography for diagnosing acute coronary syndromes and predicting clinical outcome in emergency department patients with chest pain of uncertain origin. Circulation. 2007 Apr 3;115 (13):1762–8.
- Meijboom WB, Mollet NR, Van Mieghem CA et al. 64‑Slice CT coronary angiography in patients with non-ST elevation acute coronary syndrome. Heart. 2007 Nov;93 (11):1386–92.
- Hollander JE, Chang AM, Shofer FS et al. One-year outcomes following coronary computerized tomographic angiography for evaluation of emergency department patients with potential acute coronary syndrome. Acad Emerg Med. 2009 Aug;16 (8):693–8.
- Chang SA, Choi SI, Choi EK et al. Usefulness of 64‑slice multidetector computed tomography as an initial diagnostic approach in patients with acute chest pain. Am Heart J. 2008 Aug;156 (2):375–83. Usefulness of 64‑slice multidetector computed tomography as an initial diagnostic approach in patients with acute chest pain. Am Heart J 2008;156:375–383.
Tsvetkov R.S., Mironkov A.B., Pryamikov A.D. Results of early and delayed invasive approaches in managing patients with non-ST elevation acute coronary syndrome. Russian Heart Journal. 2014;79 (5):271–277