Immediate vs Delayed Intervention for Acute Coronary Syndromes

Montalescot, Gilles; Cayla, Guillaume; Collet, Jean‐Philippe; Elhadad, Simon; Beygui, Farzin; Breton, Hervé; Choussat, Rémi; Leclercq, Florence; Silvain, Jean‐François; Duclos, F; Aout, Mounir; Dubois‐Randé, Jean‐Luc; Barthélémy, Olivier; Ducrocq, Grégory; Bellemain-Appaix, Anne; Payot, Laurent; Steg, Philippe Gabriel; Henry, Patrick; Spaulding, Christian; Vicaut, Éric; Investigators, for the ABOARD

doi:10.1001/jama.2009.1267

Cited by 266 publications

(147 citation statements)

References 33 publications

(15 reference statements)

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“…This result is supported by recent reports that early intervention made no difference in preventing primary outcome as compared with delayed approach. [20][21][22] Although our study was not differentiated in accordance with risk stratification in NSTEMI, it suggests that not only appropriate intervention time but also the presence of complete final coronary flow through any device procedure or medial approach might affect less than expected in NSTEMI patients.…”

Section: Discussionmentioning

confidence: 62%

Impact of Postprocedural TIMI Flow on Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction

et al. 2017

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SummaryThis study aimed to evaluate the clinical prognostic implications of postprocedural Thrombolysis in Myocardial Infarction (TIMI) flow in acute myocardial infarction patients. A total of 2796 ST-elevation myocardial infarction (STEMI) and 1720 non ST-elevation myocardial infarction (NSTEMI) patients treated in 8 hospitals affiliated with the Catholic University of Korea and Chonnam National University Hospital were analyzed. The study populations were divided according to the final TIMI flow. The primary outcome were the major adverse cardiac events (MACE), defined as a composite of cardiac deaths (CD), nonfatal myocardial infarctions (MI), and target lesion revascularization (TLR). Over a median follow-up of 3.3 years (minimum 2 to maximum 5 years), MACE and CD occurred more frequently in STEMI patients with TIMI !2 group than those with TIMI 3 (MACE: adjusted hazard ratio [aHR], 1.962; 95% confidence interval [CI] 1.513 to 2.546, P < 0.001, CD: aHR, 3.154, CI 2.308 to 4.309, P < 0.001). However, there was no significant difference between the two subgroups in NSTEMI (aHR, 0.932; 95% CI 0.586 to 1.484, P = 0.087). In STEMI patients, good postprocedural TIMI flow after PCI was associated with favorable clinical outcomes. And the effect of poor TIMI flow in STEMI was on death, not the components of MACE. Meanwhile, postprocedural TIMI flow had no effect on long-term outcomes in NSTEMI patients.(Int Heart J 2017; 58: 674-685)

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Section: Discussionmentioning

confidence: 62%

Impact of Postprocedural TIMI Flow on Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction

et al. 2017

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“…The amount of time between a patient's arrival at the ES and the time the blocked artery is opened, the so called "doorto-balloon time" in primary angioplasty or "door-to-needle time" in fibrinolysis, can be compromised during off-hours, and fibrinolytics are preferred to primary angioplasty for STEMI. Although it has not been established that the early invasive strategy results in lower mortality in NSTEMI, some clinically or hemodynamically unstable patients can benefit from that procedure 8,10 . The baseline clinical characteristics of the patients studied were similar, except for the higher prevalence of UA for arrival during regular hours, and of NSTEMI for arrival during off-hours.…”

Section: Discussionmentioning

confidence: 99%

Hora da admissão na unidade de emergência e mortalidade hospitalar na síndrome coronária aguda

Takada¹,

Roza²,

Ramos³

et al. 2012

Arq. Bras. Cardiol.

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“…Moreover, in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) registry, 11 very early intervention was associated with a trend toward a survival benefit. Finally, in a recent multicenter trial, 12 an early (≤24 hours) invasive strategy in NSTEMI patients showed advantage over a delayed invasive 13 only 8% of the patients in the early group has been treated with GP IIb/IIIa inhibitors, and in the ABOARD trial, 14 most of the patients in the deferred intervention were treated very early (≤24 hours from admission). The benefit of a fast invasive treatment may be linked to the high prevalence of basal impaired myocardial perfusion in NSTEMI patients, even with upstream use of GP IIb/IIIa inhibitors.…”

Section: Discussionmentioning

confidence: 98%

Comparison of Immediate vs Early Invasive Strategy in Patients With First Acute Non–ST‐Elevation Myocardial Infarction

Sciahbasi

Madonna

Vita

et al. 2010

Clinical Cardiology

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Background:The best timing for coronary angiography (immediate vs early) in patients with acute non-STelevation myocardial infarction (NSTEMI) is controversial. Hypothesis: Evaluate in NSTEMI patients the effects of an immediate compared to an early invasive strategy on microvascular damage, myocardial perfusion, and infarct size. Methods: We randomized 54 consecutive patients with first episode of NSTEMI: 27 patients (22 males, age 58.8 ± 9.4 years, group A) underwent immediate (≤6 hours) percutaneous coronary intervention (PCI) with a double bolus of eptifibatide, and 27 patients (24 males, age 59.7 ± 9.8 years, P = 0.72, group B) underwent early (7-72 hours) PCI with upstream eptifibatide. Microvascular damage was evaluated at predischarge by myocardial contrast echocardiography, and the contrast defect length was calculated.Results: There were no significant differences in pre-PCI myocardial blush grade (MBG) (41% MBG 0 or 1 in group A vs 37% MBG 0 or 1 in group B, P = 0.78), in post-PCI MBG (7.4% MBG 0 or 1 in both groups, P = 1.00), and in contrast defect length (4.5% in group A vs 2.8% in group B, P = 0.56). However, group A showed a significant reduction in creatine kinase myocardial band isoenzyme peak (26 ± 26 ng/mL in group A vs 69 ± 79 ng/mL in group B, P = 0.01) and in troponin T peak (0.84 ± 1.2 ng/mL in group A vs 1.8 ± 2.1 ng/mL in group B, P = 0.048). Conclusions:In patients with NSTEMI treated with eptifibatide, immediate PCI is associated with less increase in myonecrosis markers compared with PCI within 72 hours. There were no significant differences in myocardial perfusion between the 2 strategies. IntroductionIn patients with acute non-ST-elevation myocardial infarction (NSTEMI), an early invasive strategy with coronary angiography (CA) and subsequent revascularization through percutaneous coronary intervention (PCI) is associated with reduced rates of death and myocardial infarction (MI) in comparison with a conservative strategy. 1 Guidelines for the treatment of patients with acute coronary syndromes (ACS) recommend an early (≤72 hours) invasive strategy for patients admitted with diagnosis of NSTEMI. 2 Excluding conditions requiring emergency interventions (refractory angina, shock, and life-threatening arrhythmias), controversy remains regarding the optimal timing between hospital admission and the invasive procedure, with 2 different alternatives for the invasive approach:

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Immediate vs Delayed Intervention for Acute Coronary Syndromes

Cited by 266 publications

References 33 publications

Impact of Postprocedural TIMI Flow on Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction

Impact of Postprocedural TIMI Flow on Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction

Hora da admissão na unidade de emergência e mortalidade hospitalar na síndrome coronária aguda

Comparison of Immediate vs Early Invasive Strategy in Patients With First Acute Non–ST‐Elevation Myocardial Infarction

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