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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 02; 55(9):858-64.JACC

Abstract

OBJECTIVES

We present the 5-year clinical outcomes according to treatment strategy with additional risk stratification of the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial.

BACKGROUND

Long-term outcomes may be relevant to decide treatment strategy for patients presenting with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and elevated troponin T.

METHODS

We randomly assigned 1,200 patients to an early invasive or selective invasive strategy. The outcomes were the composite of death or myocardial infarction (MI) and its individual components. Risk stratification was performed with the FRISC (Fast Revascularization in InStability in Coronary artery disease) risk score.

RESULTS

At 5-year follow-up, revascularization rates were 81% in the early invasive and 60% in the selective invasive group. Cumulative death or MI rates were 22.3% and 18.1%, respectively (hazard ratio [HR]: 1.29, 95% confidence interval [CI]: 1.00 to 1.66, p = 0.053). No difference was observed in mortality (HR: 1.13, 95% CI: 0.80 to 1.60, p = 0.49) or MI (HR: 1.24, 95% CI: 0.90 to 1.70, p = 0.20). After risk stratification, no benefit of an early invasive strategy was observed in reducing death or spontaneous MI in any of the risk groups.

CONCLUSIONS

In patients presenting with NSTE-ACS and elevated troponin T, we could not demonstrate a long-term benefit of an early invasive strategy in reducing death or MI. (Invasive versus Conservative Treatment in Unstable coronary Syndromes [ICTUS]; ISRCTN82153174).

Authors+Show Affiliations

Department of Cardiology, Cardiac Catheterization Laboratory B2-137, Academic Medical Center-University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

20045278

Citation

Damman, Peter, 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." Journal of the American College of Cardiology, vol. 55, no. 9, 2010, pp. 858-64.
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;55(9):858-64.
Damman, P., Hirsch, A., Windhausen, F., Tijssen, J. G., & de Winter, R. J. (2010). 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. Journal of the American College of Cardiology, 55(9), 858-64. https://doi.org/10.1016/j.jacc.2009.11.026
Damman P, 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. PubMed PMID: 20045278.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Damman,Peter, AU - Hirsch,Alexander, AU - Windhausen,Fons, AU - Tijssen,Jan G P, AU - de Winter,Robbert J, AU - ,, Y1 - 2010/01/04/ PY - 2009/08/03/received PY - 2009/11/05/revised PY - 2009/11/20/accepted PY - 2010/1/5/entrez PY - 2010/1/5/pubmed PY - 2010/3/26/medline SP - 858 EP - 64 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 55 IS - 9 N2 - OBJECTIVES: We present the 5-year clinical outcomes according to treatment strategy with additional risk stratification of the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial. BACKGROUND: Long-term outcomes may be relevant to decide treatment strategy for patients presenting with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and elevated troponin T. METHODS: We randomly assigned 1,200 patients to an early invasive or selective invasive strategy. The outcomes were the composite of death or myocardial infarction (MI) and its individual components. Risk stratification was performed with the FRISC (Fast Revascularization in InStability in Coronary artery disease) risk score. RESULTS: At 5-year follow-up, revascularization rates were 81% in the early invasive and 60% in the selective invasive group. Cumulative death or MI rates were 22.3% and 18.1%, respectively (hazard ratio [HR]: 1.29, 95% confidence interval [CI]: 1.00 to 1.66, p = 0.053). No difference was observed in mortality (HR: 1.13, 95% CI: 0.80 to 1.60, p = 0.49) or MI (HR: 1.24, 95% CI: 0.90 to 1.70, p = 0.20). After risk stratification, no benefit of an early invasive strategy was observed in reducing death or spontaneous MI in any of the risk groups. CONCLUSIONS: In patients presenting with NSTE-ACS and elevated troponin T, we could not demonstrate a long-term benefit of an early invasive strategy in reducing death or MI. (Invasive versus Conservative Treatment in Unstable coronary Syndromes [ICTUS]; ISRCTN82153174). SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/20045278/5_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_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)03925-4 DB - PRIME DP - Unbound Medicine ER -