Tags

Type your tag names separated by a space and hit enter

Timing of angiography with a routine invasive strategy and long-term outcomes in non-ST-segment elevation acute coronary syndrome: a collaborative analysis of individual patient data from the FRISC II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) Trials.
JACC Cardiovasc Interv. 2012 Feb; 5(2):191-9.JC

Abstract

OBJECTIVES

This study sought to investigate long-term outcomes after early or delayed angiography in patients with non-ST-segment elevation acute coronary syndrome (nSTE-ACS) undergoing a routine invasive management.

BACKGROUND

The optimal timing of angiography in patients with nSTE-ACS is currently a topic for debate.

METHODS

Long-term follow-up after early (within 2 days) angiography versus delayed (within 3 to 5 days) angiography was investigated in the FRISC-II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) (FIR) nSTE-ACS patient-pooled database. The main outcome was cardiovascular death or myocardial infarction up to 5-year follow-up. Hazard ratios (HR) were calculated with Cox regression models. Adjustments were made for the FIR risk score, study, and the propensity of receiving early angiography using inverse probability weighting.

RESULTS

Of 2,721 patients originally randomized to the routine invasive arm, consisting of routine angiography and subsequent revascularization if suitable, 975 underwent early angiography and 1,141 delayed angiography. No difference was observed in 5-year cardiovascular death or myocardial infarction in unadjusted (HR: 1.06, 95% confidence interval [CI]: 0.79 to 1.42, p=0.61) and adjusted (HR: 0.93, 95% CI: 0.75 to 1.16, p=0.54) Cox regression models.

CONCLUSIONS

In the FIR database of patients presenting with nSTE-ACS, the timing of angiography was not related to long-term cardiovascular mortality or myocardial infarction. (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes [ICTUS]; ISRCTN82153174. Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction [the Third Randomised Intervention Treatment of Angina Trials (RITA-3)]; ISRCTN07752711).

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Damman P
Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
van Geloven N
No affiliation info available
Wallentin L
No affiliation info available
Lagerqvist B
No affiliation info available
Fox KA
No affiliation info available
Clayton T
No affiliation info available
Pocock SJ
No affiliation info available
Hirsch A
No affiliation info available
Windhausen F
No affiliation info available
Tijssen JG
No affiliation info available
de Winter RJ
No affiliation info available

MeSH

Acute Coronary SyndromeAgedAngina, UnstableConfidence IntervalsCooperative BehaviorCoronary AngiographyFemaleHealth Status IndicatorsHumansMaleMiddle AgedMyocardial InfarctionProportional Hazards ModelsProspective StudiesStatistics as TopicTime FactorsTreatment Outcome

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22361604

Citation

Damman, Peter, et al. "Timing of Angiography With a Routine Invasive Strategy and Long-term Outcomes in non-ST-segment Elevation Acute Coronary Syndrome: a Collaborative Analysis of Individual Patient Data From the FRISC II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) Trials." JACC. Cardiovascular Interventions, vol. 5, no. 2, 2012, pp. 191-9.
Damman P, van Geloven N, Wallentin L, et al. Timing of angiography with a routine invasive strategy and long-term outcomes in non-ST-segment elevation acute coronary syndrome: a collaborative analysis of individual patient data from the FRISC II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) Trials. JACC Cardiovasc Interv. 2012;5(2):191-9.
Damman, P., van Geloven, N., Wallentin, L., Lagerqvist, B., Fox, K. A., Clayton, T., Pocock, S. J., Hirsch, A., Windhausen, F., Tijssen, J. G., & de Winter, R. J. (2012). Timing of angiography with a routine invasive strategy and long-term outcomes in non-ST-segment elevation acute coronary syndrome: a collaborative analysis of individual patient data from the FRISC II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) Trials. JACC. Cardiovascular Interventions, 5(2), 191-9. https://doi.org/10.1016/j.jcin.2011.10.016
Damman P, et al. Timing of Angiography With a Routine Invasive Strategy and Long-term Outcomes in non-ST-segment Elevation Acute Coronary Syndrome: a Collaborative Analysis of Individual Patient Data From the FRISC II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) Trials. JACC Cardiovasc Interv. 2012;5(2):191-9. PubMed PMID: 22361604.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Timing of angiography with a routine invasive strategy and long-term outcomes in non-ST-segment elevation acute coronary syndrome: a collaborative analysis of individual patient data from the FRISC II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) Trials. AU - Damman,Peter, AU - van Geloven,Nan, AU - Wallentin,Lars, AU - Lagerqvist,Bo, AU - Fox,Keith A A, AU - Clayton,Tim, AU - Pocock,Stuart J, AU - Hirsch,Alexander, AU - Windhausen,Fons, AU - Tijssen,Jan G P, AU - de Winter,Robbert J, PY - 2011/07/13/received PY - 2011/09/19/revised PY - 2011/10/28/accepted PY - 2012/2/25/entrez PY - 2012/3/1/pubmed PY - 2012/7/10/medline SP - 191 EP - 9 JF - JACC. Cardiovascular interventions JO - JACC Cardiovasc Interv VL - 5 IS - 2 N2 - OBJECTIVES: This study sought to investigate long-term outcomes after early or delayed angiography in patients with non-ST-segment elevation acute coronary syndrome (nSTE-ACS) undergoing a routine invasive management. BACKGROUND: The optimal timing of angiography in patients with nSTE-ACS is currently a topic for debate. METHODS: Long-term follow-up after early (within 2 days) angiography versus delayed (within 3 to 5 days) angiography was investigated in the FRISC-II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) (FIR) nSTE-ACS patient-pooled database. The main outcome was cardiovascular death or myocardial infarction up to 5-year follow-up. Hazard ratios (HR) were calculated with Cox regression models. Adjustments were made for the FIR risk score, study, and the propensity of receiving early angiography using inverse probability weighting. RESULTS: Of 2,721 patients originally randomized to the routine invasive arm, consisting of routine angiography and subsequent revascularization if suitable, 975 underwent early angiography and 1,141 delayed angiography. No difference was observed in 5-year cardiovascular death or myocardial infarction in unadjusted (HR: 1.06, 95% confidence interval [CI]: 0.79 to 1.42, p=0.61) and adjusted (HR: 0.93, 95% CI: 0.75 to 1.16, p=0.54) Cox regression models. CONCLUSIONS: In the FIR database of patients presenting with nSTE-ACS, the timing of angiography was not related to long-term cardiovascular mortality or myocardial infarction. (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes [ICTUS]; ISRCTN82153174. Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction [the Third Randomised Intervention Treatment of Angina Trials (RITA-3)]; ISRCTN07752711). SN - 1876-7605 UR - https://www.unboundmedicine.com/medline/citation/22361604/Timing_of_angiography_with_a_routine_invasive_strategy_and_long_term_outcomes_in_non_ST_segment_elevation_acute_coronary_syndrome:_a_collaborative_analysis_of_individual_patient_data_from_the_FRISC_II__Fragmin_and_Fast_Revascularization_During_Instability_in_Coronary_Artery_Disease__ICTUS__Invasive_Versus_Conservative_Treatment_in_Unstable_Coronary_Syndromes__and_RITA_3__Intervention_Versus_Conservative_Treatment_Strategy_in_Patients_With_Unstable_Angina_or_Non_ST_Elevation_Myocardial_Infarction__Trials_ DB - PRIME DP - Unbound Medicine ER -
Grapherence [↓12]

Related Citations

More