Immediate versus deferred coronary angioplasty in non-ST-segment elevation acute coronary syndromes
- R K Riezebos1,
- E Ronner1,
- E ter Bals1,
- T Slagboom1,
- P C Smits2,
- J M ten Berg3,
- F Kiemeneij1,
- G Amoroso1,
- M S Patterson1,
- M J Suttorp3,
- J G P Tijssen4,
- G J Laarman5,
- for the OPTIMA trial
- 1Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
- 2Medisch Centrum Rijnmond-Zuid, Rotterdam, The Netherlands
- 3St Antonius Hospital, Nieuwegein, The Netherlands
- 4Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- 5Kings College Hospital, London, UK
- Dr R K Riezebos, Onze Lieve Vrouwe Gasthuis, Department of Interventional Cardiology, Postbus 95500, 1090 HM Amsterdam, The Netherlands; R.K.Riezebos{at}xs4all.nl
- Accepted 25 November 2008
- Published Online First 19 December 2008
Abstract
Background: The field of acute coronary syndromes is characterised by an increasing tendency towards early invasive catheter-based diagnostics and therapeutics—a practice based on observational and retrospective data.
Objective: To compare immediate versus deferred angioplasty in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS)
Methods: A randomised, prospective multicentre trial was performed in patients admitted with NSTE-ACS, eligible for percutaneous coronary intervention (PCI). Interim analysis was performed after enrolment of 251 patients; PCI was appropriate in 142 patients. These patients were randomised to immediate PCI (n = 73) or deferred PCI (24–48 h) (n = 69). Patients received protocol-driven glycoprotein IIb/IIIa blockers, aspirin and clopidogrel. The primary end point was a composite of death, non-fatal myocardial infarction (MI) or unplanned revascularisation, at 30 days. After hospital discharge outpatient follow-up was performed at 30 days and 6 months.
Results: The incidence at 30 days of the primary end point was 60% in the group receiving immediate PCI and 39% in the group receiving deferred PCI (relative risk (RR) = 1.5, 95% CI 1.09 to 2.15; p = 0.004). No deaths occurred in either group. MI was significantly more common in the group receiving immediate PCI (60% vs 38%, RR = 1.6, 95% CI 1.12 to 2.28, p = 0.005). Unplanned revascularisation was similar in both groups. The observed difference was preserved over 6-months’ follow-up.
Conclusions: Immediate PCI was associated with an increased rate of MI in comparison with a 24–48 h deferred strategy, despite aggressive antithrombotic treatment. The results suggest that PCI for high-risk patients with non-refractory NSTE-ACS should be delayed for at least 24 h after hospital admission.
Trial registration number: ISRCTN80874637
Footnotes
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Funding: The study was supported by the Netherlands Heart Foundation: research grant number: 2003B282.
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Competing interests: None.
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Ethics approval: All (local) medical ethics committees approved the trial.
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The funding agency had no influence on the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review, or approval of the manuscript.
