Thursday, May 04, 2017

“Early” invasive versus selectively invasive strategy for non ST segment ACS

Here is the paper in question. I put the word early in quotes because it meant cath within 48 hours, not an immediate cath. From the paper:

Methods The ICTUS trial was a multicenter, randomized controlled clinical trial that included 1,200 patients with NSTE-ACS and an elevated cardiac troponin T. Enrollment was from July 2001 to August 2003. We collected 10-year follow-up of death, myocardial infarction (MI), and revascularization through the Dutch population registry, patient phone calls, general practitioners, and hospital records. The primary outcome was the 10-year composite of death or spontaneous MI. Additional outcomes included the composite of death or MI, death, MI (spontaneous and procedure-related), and revascularization…

Conclusions In patients with NSTE-ACS and elevated cardiac troponin T levels, an early invasive strategy has no benefit over a selective invasive strategy in reducing the 10-year composite outcome of death or spontaneous MI, and a selective invasive strategy may be a viable option in selected patients.

Don’t confuse this with another debate now raging concerning NSTEMI, which is whether such patients should go to the cath lab immediately rather than wait up to 48 hours. Clearly there are some, quite a few in fact, at least among NSTEMI patients as they are defined according to prevailing performance measures, who should. These patients often have ECG findings which, though not meeting the criteria for STEMI, suggest acute epicardial coronary occlusion or impending occlusion. A closely related debate is whether the STEMI/NSTEMI designation is even useful at all.

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