The invasive strategy is preferred to treat patients with acute coronary syndromes without ST-segment elevation, but the ideal time for the procedure is controversial. This study randomized 542 patients with acute coronary syndrome without high-risk ST elevation to carry out immediate (invasive treatment within 12 hours) or late treatment (after 48 hours). The primary endpoint was a combination of death, re-infarction and recurrent ischemia at 30 days. The secondary endpoint was the extent of myocardial damage as measured by troponin level 72-96 hours after admission and the percentage of patients with increased CK-MB during hospitalization.
The median time to angiography for the early invasive group was 2.6 hours and 54.9 hours for the late invasive group. There was no difference in the primary endpoint between the two groups (9.9% vs 14.2% respectively, p=0.135). There were also no differences in the secondary endpoints. The length of hospital stay was lower for the early invasive group.
Conclusion: Although we cannot draw a definite conclusion due to the occurrence of events that was lower than expected, the immediate invasive strategy was safe but not superior to the late invasive strategy.
Erik Badings, MD, MsC.
2013-05-23
Original title: Early or late intervention in high-risk NSTE-ACS patient: results of the ELISA-3trial.
