Comparison of Acute Versus Subacute Coronary Angiography in Patients With NON-ST-Elevation Myocardial Infarction (from the NONSTEMI Trial)
Copyright © 2019 Elsevier Inc. All rights reserved..
The optimal timing of coronary angiography (CAG) in high-risk patients with acute coronary syndrome without persisting ST-segment elevation (NST-ACS) remains undetermined. The NON-ST-Elevation Myocardial Infarction trial aimed to compare outcomes in NSTE-ACS patients randomized to acute CAG (STEMI-like approach) with patients randomized to medical therapy and subacute CAG. We randomized 496 patients with suspected NST-ACS based on symptoms and significant regional ST depressions and/or elevated point-of-care troponin T (POC-cTnT) (≥50 ng/l) to either acute CAG (<2 hours, n = 245) or subacute CAG (<72 hours, n = 251). The primary end point was a composite of all-cause death, reinfarction, and readmission with congestive heart failure within 1 year from randomization. A final acute coronary syndrome (ACS) diagnosis was assigned to 429 (86.5%) patients. The median time from randomization to revascularization was 1.3 hours in the acute CAG group versus 51.1 hours in the subacute CAG group (p <0.001). The composite end point occurred in 25 patients (10.2%) in the acute CAG group and 29 (11.6%) in the subacute CAG group, p = 0.62. The acute CAG group had a 1-year all-cause mortality of 5.7% compared with 5.6% in the subacute CAG group, p = 0.96. In conclusion, neither the composite end point of all-cause death, reinfarction, and readmission with congestive heart failure nor mortality differed between an acute and subacute CAG approach in NSTE-ACS patients. However, identification of NSTE-ACS patients in the prehospital phase and direct triage to an invasive center is feasible, safe and may facilitate early diagnosis and revascularization.
| Errataetall: |
CommentIn: Am J Cardiol. 2020 Jul 1;126:108-109. - PMID 32359716 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:124 |
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| Enthalten in: |
The American journal of cardiology - 124(2019), 6 vom: 15. Sept., Seite 825-832 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Rasmussen, Martin B [VerfasserIn] |
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| Links: |
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| Themen: |
Clinical Trial, Phase II |
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| Anmerkungen: |
Date Completed 04.03.2020 Date Revised 04.03.2020 published: Print-Electronic ClinicalTrials.gov: NCT01638806 CommentIn: Am J Cardiol. 2020 Jul 1;126:108-109. - PMID 32359716 Citation Status MEDLINE |
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| doi: |
10.1016/j.amjcard.2019.06.007 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM299368238 |
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| 245 | 1 | 0 | |a Comparison of Acute Versus Subacute Coronary Angiography in Patients With NON-ST-Elevation Myocardial Infarction (from the NONSTEMI Trial) |
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| 500 | |a Date Revised 04.03.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT01638806 | ||
| 500 | |a CommentIn: Am J Cardiol. 2020 Jul 1;126:108-109. - PMID 32359716 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2019 Elsevier Inc. All rights reserved. | ||
| 520 | |a The optimal timing of coronary angiography (CAG) in high-risk patients with acute coronary syndrome without persisting ST-segment elevation (NST-ACS) remains undetermined. The NON-ST-Elevation Myocardial Infarction trial aimed to compare outcomes in NSTE-ACS patients randomized to acute CAG (STEMI-like approach) with patients randomized to medical therapy and subacute CAG. We randomized 496 patients with suspected NST-ACS based on symptoms and significant regional ST depressions and/or elevated point-of-care troponin T (POC-cTnT) (≥50 ng/l) to either acute CAG (<2 hours, n = 245) or subacute CAG (<72 hours, n = 251). The primary end point was a composite of all-cause death, reinfarction, and readmission with congestive heart failure within 1 year from randomization. A final acute coronary syndrome (ACS) diagnosis was assigned to 429 (86.5%) patients. The median time from randomization to revascularization was 1.3 hours in the acute CAG group versus 51.1 hours in the subacute CAG group (p <0.001). The composite end point occurred in 25 patients (10.2%) in the acute CAG group and 29 (11.6%) in the subacute CAG group, p = 0.62. The acute CAG group had a 1-year all-cause mortality of 5.7% compared with 5.6% in the subacute CAG group, p = 0.96. In conclusion, neither the composite end point of all-cause death, reinfarction, and readmission with congestive heart failure nor mortality differed between an acute and subacute CAG approach in NSTE-ACS patients. However, identification of NSTE-ACS patients in the prehospital phase and direct triage to an invasive center is feasible, safe and may facilitate early diagnosis and revascularization | ||
| 650 | 4 | |a Clinical Trial, Phase II | |
| 650 | 4 | |a Clinical Trial, Phase III | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 7 | |a Troponin T |2 NLM | |
| 700 | 1 | |a Stengaard, Carsten |e verfasserin |4 aut | |
| 700 | 1 | |a Sørensen, Jacob T |e verfasserin |4 aut | |
| 700 | 1 | |a Riddervold, Ingunn S |e verfasserin |4 aut | |
| 700 | 1 | |a Søndergaard, Hanne M |e verfasserin |4 aut | |
| 700 | 1 | |a Niemann, Troels |e verfasserin |4 aut | |
| 700 | 1 | |a Dodt, Karen Kaae |e verfasserin |4 aut | |
| 700 | 1 | |a Frost, Lars |e verfasserin |4 aut | |
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| 700 | 1 | |a Kristensen, Steen D |e verfasserin |4 aut | |
| 700 | 1 | |a Maeng, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Christiansen, Evald H |e verfasserin |4 aut | |
| 700 | 1 | |a Terkelsen, Christian J |e verfasserin |4 aut | |
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