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Early Versus Standard Care Invasive Examination and Treatment of Patients With Non-ST-Segment Elevation Acute Coronary Syndrome
- Source :
- Kofoed, K F, Kelbæk, H, Hansen, P R, Torp-Pedersen, C, Høfsten, D, Kløvgaard, L, Holmvang, L, Helqvist, S, Jørgensen, E, Galatius, S, Pedersen, F, Bang, L, Saunamaki, K, Clemmensen, P, Linde, J J, Heitmann, M, Wendelboe Nielsen, O, Raymond, I E, Kristiansen, O P, Svendsen, I H, Bech, J, Dominguez Vall-Lamora, M H, Kragelund, C, Hansen, T F, Dahlgaard Hove, J, Jørgensen, T, Fornitz, G G, Steffensen, R, Jurlander, B, Abdulla, J, Lyngbæk, S, Elming, H, Therkelsen, S K, Abildgaard, U, Jensen, J S, Gislason, G, Køber, L V & Engstrøm, T 2018, ' Early versus standard care invasive examination and treatment of patients with non-ST-segment elevation acute coronary syndrome : VERDICT Randomized Controlled Trial ', Circulation, vol. 138, no. 24, pp. 2741-2750 . https://doi.org/10.1161/CIRCULATIONAHA.118.037152, Kofoed, K F, Kelbæk, H, Riis Hansen, P, Torp-Pedersen, C, Høfsten, D, Kløvgaard, L, Holmvang, L, Helqvist, S, Jørgensen, E, Galatius, S, Pedersen, F, Bang, L, Saunamaki, K, Clemmensen, P, Linde, J J, Heitmann, M, Wendelboe Nielsen, O, Raymond, I E, Peter Kristiansen, O, Hastrup Svendsen, I, Bech, J, Dominguez Vall-Lamora, M H, Kragelund, C, Fritz Hansen, T, Dahlgaard Hove, J, Jørgensen, T, Fornitz, G G, Steffensen, R, Jurlander, B, Abdulla, J, Lyngbæk, S, Elming, H, Krohn Therkelsen, S, Abildgaard, U, Skov Jensen, J, Gislason, G, Køber, L V & Engstrøm, T 2018, ' Early versus standard care invasive examination and treatment of patients with non-ST-segment elevation acute coronary syndrome : verdict randomized controlled trial ', Circulation, vol. 138, no. 24, pp. 2741-2750 . https://doi.org/10.1161/CIRCULATIONAHA.118.037152
- Publication Year :
- 2018
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2018.
-
Abstract
- Background: The optimal timing of invasive coronary angiography (ICA) and revascularization in patients with non-ST-segment elevation acute coronary syndrome is not well defined. We tested the hypothesis that a strategy of very early ICA and possible revascularization within 12 hours of diagnosis is superior to an invasive strategy performed within 48 to 72 hours in terms of clinical outcomes. Methods: Patients admitted with clinical suspicion of non-ST-segment elevation acute coronary syndrome in the Capital Region of Copenhagen, Denmark, were screened for inclusion in the VERDICT trial (Very Early Versus Deferred Invasive Evaluation Using Computerized Tomography) ( ClinicalTrials.gov NCT02061891). Patients with ECG changes indicating new ischemia or elevated troponin, in whom ICA was clinically indicated and deemed logistically feasible within 12 hours, were randomized 1:1 to ICA within 12 hours or standard invasive care within 48 to 72 hours. The primary end point was a combination of all-cause death, nonfatal recurrent myocardial infarction, hospital admission for refractory myocardial ischemia, or hospital admission for heart failure. Results: A total of 2147 patients were randomized; 1075 patients allocated to very early invasive evaluation had ICA performed at a median of 4.7 hours after randomization, whereas 1072 patients assigned to standard invasive care had ICA performed 61.6 hours after randomization. Among patients with significant coronary artery disease identified by ICA, coronary revascularization was performed in 88.4% (very early ICA) and 83.1% (standard invasive care). Within a median follow-up time of 4.3 (interquartile range, 4.1–4.4) years, the primary end point occurred in 296 (27.5%) of participants in the very early ICA group and 316 (29.5%) in the standard care group (hazard ratio, 0.92; 95% CI, 0.78–1.08). Among patients with a GRACE risk score (Global Registry of Acute Coronary Events) >140, a very early invasive treatment strategy improved the primary outcome compared with the standard invasive treatment (hazard ratio, 0.81; 95% CI, 0.67–1.01; P value for interaction=0.023). Conclusions: A strategy of very early invasive coronary evaluation does not improve overall long-term clinical outcome compared with an invasive strategy conducted within 2 to 3 days in patients with non-ST-segment elevation acute coronary syndrome. However, in patients with the highest risk, very early invasive therapy improves long-term outcomes. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02061891.
- Subjects :
- Male
medicine.medical_specialty
Acute coronary syndrome
Troponin/metabolism
medicine.medical_treatment
clinical outcome
030204 cardiovascular system & hematology
Revascularization
time factors
acute coronary syndrome
03 medical and health sciences
0302 clinical medicine
Standard care
Risk Factors
Physiology (medical)
Internal medicine
medicine
Humans
ST segment
In patient
030212 general & internal medicine
Percutaneous Coronary Intervention/adverse effects
Proportional Hazards Models
Aged
Coronary Angiography/methods
business.industry
Elevation
PCI
Middle Aged
medicine.disease
Acute Coronary Syndrome/diagnosis
Invasive coronary angiography
Heart Arrest/etiology
Treatment Outcome
Cardiology
Female
coronary revascularization
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 15244539 and 00097322
- Volume :
- 138
- Database :
- OpenAIRE
- Journal :
- Circulation
- Accession number :
- edsair.doi.dedup.....4f3372479a0e32f4d8b2b0621f59e106
- Full Text :
- https://doi.org/10.1161/circulationaha.118.037152