[Early invasive strategy no better than a selective invasive strategy for patients with non-ST-segment elevation acute coronary syndromes and elevated cardiac troponin T levels: long-term follow-up results of the ICTUS trial]. / Vroeg invasieve behandelstrategie niet beter dan selectiefinvasieve bij patiënten met een acuut coronair syndroom zonder ST-elevatie en met een verhoogde troponinewaarde: langetermijnresultaten van de ICTUS-studie.
Ned Tijdschr Geneeskd
; 152(8): 437-44, 2008 Feb 23.
Article
em Nl
| MEDLINE
| ID: mdl-18361193
ABSTRACT
OBJECTIVE:
To determine whether routine coronary angiography followed by revascularisation where appropriate is better than initial drug treatment in patients with non-ST-segment elevation acute coronary syndromes (nSTE-ACS) and elevated troponin T concentrations.DESIGN:
Multicentre randomised clinical trial (www.controlled-trials. com, number SRCTN82153174).METHOD:
Patients with nSTE-ACS and elevated cardiac troponin were randomly assigned to an early invasive strategy or a selective invasive strategy. The early invasive strategy consisted of coronary angiography and revascularisation as indicated within 48 hours. The selective invasive strategy consisted of initial drug therapy; catheterisation was performed if the patient developed refractory angina or recurrent ischaemia. The main endpoints were a composite of death, recurrent myocardial infarction and rehospitalisation for anginal symptoms within 3 years, and all-cause mortality within 4 years.RESULTS:
A total of 1200 patients were enrolled from 42 hospitals in the Netherlands. The in-hospital revascularisation rate was 76% in the early invasive group and 40% in the selective invasive group. After 3 years, the cumulative rate for the composite endpoint was 30.0% in the early invasive group and 26.0% in the selective invasive group (hazard ratio 1.21; 95% CI 0.97-1.50; p = 0.09). The 4-year all-cause mortality rate was similar in both treatment groups (7.9% vs 7.7%; p = 0.62).CONCLUSION:
Long-term follow-up of this trial suggests that an early invasive strategy is not better than a selective invasive strategy in patients with nSTE-ACS and elevated cardiac troponin. Therefore, implementation of either strategy is acceptable in these patients.
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Base de dados:
MEDLINE
Idioma:
Nl
Ano de publicação:
2008
Tipo de documento:
Article