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. 2008 Feb 23;152(8):437-44.

[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]

[Article in Dutch]
F Windhausen  1 , A Hirsch, J G P Tijssen, F W A Verheugt, J H Cornel, R J de Winter
Affiliations
  • PMID: 18361193

[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]

[Article in Dutch]
F Windhausen et al. Ned Tijdschr Geneeskd. .

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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