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Two-year outcome after early or late Intervention in non-ST elevation acute coronary syndrome

View Article: PubMed Central - PubMed

ABSTRACT

Objective: To compare long-term outcome of an early to a delayed invasive strategy in high-risk patients with non-ST elevation acute coronary syndrome (NSTE-ACS).

Methods: This prospective, multicentre trial included patients with NSTE-ACS and at least two out of three of the following high-risk criteria: (1) evidence of extensive myocardial ischaemia on ECG, (2) elevated biomarkers for myocardial necrosis and (3) age above 65 years. Patients were randomised to either an early (angiography and revascularisation if appropriate <12 hours) or a delayed invasive strategy (>48 hours after randomisation). Endpoint for this prespecified long-term follow-up was the composite incidence of death or reinfarction after 2 years. Data collection was performed by telephone contact with the patients, their relatives or general practitioner and by review of hospital records.

Results: Endpoint status after 2-year follow-up was collected in 521 of 542 initially enrolled patients. Incidence of death or reinfarction was 11.8% in the early and 13.1% in the delayed treatment group (relative risk (RR)=0.90, 95% CI 0.57 to 1.42). No significant differences were found in occurrence of the individual components of the primary endpoint: death 6.1% vs 8.9%, RR 0.69 (95% CI 0.37 to 1.27), reinfarction 6.5% vs 5.4%, RR 1.20 (95% CI 0.60 to 2.38). Post-hoc subgroup analysis showed statistical significant interaction between age and treatment strategy on outcome (p=0.02).

Conclusions: After 2 years follow-up, no difference in incidence of death or reinfarction was seen between early to late invasive strategy. These findings are in line with results of other studies with longer follow-up. Older patients seem to benefit more from early invasive treatment.

No MeSH data available.


Kaplan-Meier curve for event free survival of primary endpoint.
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Figure 2: Kaplan-Meier curve for event free survival of primary endpoint.

Mentions: The original publication of the ELISA-3 trial showed a non-significant reduction of 30% in the early invasive treated patients on the primary composite endpoint of death, reinfarction or recurrent ischaemia after 30-day follow-up.7 Median duration of hospitalisation in this group was statistically significant shorter (4 days, vs 6 days in the late treatment group). Two-years follow-up could be performed in 521 patients, 96% of the initially enrolled patients. The cumulative incidence of death or reinfarction after 2-years follow-up did not differ significantly (figure 2; log rank test p=0.67). This combined endpoint occurred in 11.8% of patients in the the early invasive group and 13.1% in the delayed treatment group (relative risk (RR)=0.90, 95% CI 0.57 to 1.42, table 3). No significant differences were found in the occurrence of the individual components of the primary endpoint: the rate of death (6.1% vs 8.9%, RR 0.69, 95% CI 0.37 to 1.27) and recurrent myocardial infarction (6.5% vs 5.4%, RR 1.20, 95% CI 0.60 to 2.38).


Two-year outcome after early or late Intervention in non-ST elevation acute coronary syndrome
Kaplan-Meier curve for event free survival of primary endpoint.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5384464&req=5

Figure 2: Kaplan-Meier curve for event free survival of primary endpoint.
Mentions: The original publication of the ELISA-3 trial showed a non-significant reduction of 30% in the early invasive treated patients on the primary composite endpoint of death, reinfarction or recurrent ischaemia after 30-day follow-up.7 Median duration of hospitalisation in this group was statistically significant shorter (4 days, vs 6 days in the late treatment group). Two-years follow-up could be performed in 521 patients, 96% of the initially enrolled patients. The cumulative incidence of death or reinfarction after 2-years follow-up did not differ significantly (figure 2; log rank test p=0.67). This combined endpoint occurred in 11.8% of patients in the the early invasive group and 13.1% in the delayed treatment group (relative risk (RR)=0.90, 95% CI 0.57 to 1.42, table 3). No significant differences were found in the occurrence of the individual components of the primary endpoint: the rate of death (6.1% vs 8.9%, RR 0.69, 95% CI 0.37 to 1.27) and recurrent myocardial infarction (6.5% vs 5.4%, RR 1.20, 95% CI 0.60 to 2.38).

View Article: PubMed Central - PubMed

ABSTRACT

Objective: To compare long-term outcome of an early to a delayed invasive strategy in high-risk patients with non-ST elevation acute coronary syndrome (NSTE-ACS).

Methods: This prospective, multicentre trial included patients with NSTE-ACS and at least two out of three of the following high-risk criteria: (1) evidence of extensive myocardial ischaemia on ECG, (2) elevated biomarkers for myocardial necrosis and (3) age above 65 years. Patients were randomised to either an early (angiography and revascularisation if appropriate <12 hours) or a delayed invasive strategy (>48 hours after randomisation). Endpoint for this prespecified long-term follow-up was the composite incidence of death or reinfarction after 2 years. Data collection was performed by telephone contact with the patients, their relatives or general practitioner and by review of hospital records.

Results: Endpoint status after 2-year follow-up was collected in 521 of 542 initially enrolled patients. Incidence of death or reinfarction was 11.8% in the early and 13.1% in the delayed treatment group (relative risk (RR)=0.90, 95% CI 0.57 to 1.42). No significant differences were found in occurrence of the individual components of the primary endpoint: death 6.1% vs 8.9%, RR 0.69 (95% CI 0.37 to 1.27), reinfarction 6.5% vs 5.4%, RR 1.20 (95% CI 0.60 to 2.38). Post-hoc subgroup analysis showed statistical significant interaction between age and treatment strategy on outcome (p=0.02).

Conclusions: After 2 years follow-up, no difference in incidence of death or reinfarction was seen between early to late invasive strategy. These findings are in line with results of other studies with longer follow-up. Older patients seem to benefit more from early invasive treatment.

No MeSH data available.