Long-term outcome after an early invasive versus selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome and elevated cardiac troponin T (the ICTUS trial): a follow-up study  

Oleh:

Hirsch, Alexander ; Windhausen, Fons ; G.P. Tijssen, Jan ; Freek, W.A. Verheugt ; Hein Cornel, Jan ; J de Winter, Robbert

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The Lancet (keterangan: ada di Proquest) vol. 369 no. 9564 (Mar. 2007), page 827.

Ketersediaan

Perpustakaan FK Nomor Panggil: L01.K.2007.02 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Background The ICTUS trial was a study that compared an early invasive with a selective invasive treatment strategy , in patients with non-ST-elevation acute coronary syndrome (nSTE-ACS). The study reported no difference between' the strategies for frequency of death, myocardial infarction, or rehospitalisation after 1 year. We did a follow-up study to assess the effects of these treatment strategies after 4 years. Methods 1200 patients with nSTE-ACS and an elevated cardiac troponin were enrolled from 42 hospitals in the Netherlands. Patients were randomly assigned either to an early invasive strategy, including early routine catheterisation ~ and revascularisation where appropriate, or to a more selective invasive strategy, where catheterisation was done if the 0 patient had refractory angina or recurrent ischaemia. The main endpoints for the current follow-up study were death, ~ recurrent myocardial infarction, or rehospitalisation for anginal symptoms within 3 years after randomisation, and (I cardiovascular mortality and all-cause mortality within 4 years. Analysis was by intention-to-treat. This study is a, registered as an International Standard Randomised Controlled Trial, number ISRCTN82153174. 0 A Findings The in-hospital revascularisation rate was 76% in the early invasive group and 40% in the selective invasive (J c, group. After 3 years, the cumulative rate for the combined endpoint was 30.0% in the early invasive group compared Dr with 26.0% in the selective invasive group (hazard ratio 1.21; 95% CI 0.97-1.50; p=0.09). Myocardial infarction was D, more frequent in the early invasive strategy group (106 [18.3%] vs 69 [12.3%]; HR 1.61; 1.19-2.18; p=0.002). Rates of 82 death or spontaneous myocardial infarction were not different (76 [14.3%] patients in the early invasive and c. 22 63 [11.2%] patients in the selective invasive strategy [HR 1.19; 0.86-1.67; p=O. 30]). No difference in all-cause mortality Ne (7.9% vs 7.7%; p=O. 62) or cardiovascular mortality (4.5% vs 5.0%; p=O. 97) was seen within 4 years. Interpretation Long-term follow-up of the ICTUS trial suggests that an early invasive strategy might not be better than a more selective invasive strategy in patients with nSTE-AC S and an elevated cardiac troponin, and implementation of either strategy might be acceptable in these patients.

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