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Immediate versus deferred coronary angioplasty in non-ST-elevation acute coronary syndromes
  1. Robert K Riezebos (r.k.riezebos{at}xs4all.nl)
  1. Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
    1. Eelko Ronner
    1. Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
      1. Edske Ter Bals
      1. Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
        1. Ton Slagboom
        1. Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
          1. Pieter C Smits
          1. Medisch Centrum Rijnmond-Zuid, Rotterdam, Netherlands
            1. Jurrien M ten Berg
            1. St Antonius Hospital, Nieuwegein, Netherlands
              1. Ferdinand Kiemeneij
              1. Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
                1. Giovanni Amoroso
                1. Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
                  1. Mark S Patterson
                  1. Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
                    1. Maarten J Suttorp
                    1. St Antonius Hospital, Nieuwegein, Netherlands
                      1. Jan GP Tijssen
                      1. Academic Medical Center – University of Amsterdam, Amsterdam, Netherlands
                        1. Gerrit Jan Laarman
                        1. Kings College Hospital, London, United Kingdom

                          Abstract

                          Objectives: The purpose of the study was to compare immediate versus deferred angioplasty in patients with non-ST-segment- elevation acute coronary syndromes

                          Background: The field of acute coronary syndromes is currently characterized by an increasing tendency towards early invasive catheter based diagnostics and therapeutics. However, this practice is based on merely observational and retrospective data.

                          Methods: A randomized and prospective multicenter trial was performed in patients admitted with NSTE-ACS, eligible for PCI. 251 patients with acute coronary angiography were enrolled. The coronary anatomy was appropriate for PCI in 142 patients. These patients were randomized to immediate PCI (n=73) or deferred PCI (24-48 hours) (n=69). Patients received protocol driven glycoprotein 2b3a blockers, aspirin and clopidogrel. The primary endpoint was a composite of death, nonfatal myocardial infarction (MI)or unplanned revascularization, at 30 days. After hospital discharge out-patient follow up was performed at 30 days and 6 months.

                          Results: The incidence at 30 days of the primary endpoint was 60 percent in the group assigned to immediate PCI and 39 percent in the group assigned to deferred PCI. (Relative risk 1.5, 95 percent, CI 1.09-2.15; p=0.004). Myocardial infarction was significantly more frequent in the group assigned to immediate PCI (60 percent vs 37 percent, relative risk 1.6, CI 1.12-2.28, p=0.005). The observed difference was preserved over a 6 month follow up period.

                          Conclusions: Immediate PCI was associated with an increased rate of MI as compared to a 24-48 hours deferred strategy, in spite of an aggressive antithrombotic treatment. The results suggest that PCI for high-risk, non-refractory NSTE-ACS should be delayed for at least 24 hours after hospital admission.

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