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Randomized Controlled Trial
. 2010 Mar 2;55(9):858-64.
doi: 10.1016/j.jacc.2009.11.026. Epub 2010 Jan 4.

5-year clinical outcomes in the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial a randomized comparison of an early invasive versus selective invasive management in patients with non-ST-segment elevation acute coronary syndrome

Peter Damman  1 , Alexander Hirsch, Fons Windhausen, Jan G P Tijssen, Robbert J de Winter; ICTUS Investigators
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Free article
Randomized Controlled Trial

5-year clinical outcomes in the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial a randomized comparison of an early invasive versus selective invasive management in patients with non-ST-segment elevation acute coronary syndrome

Peter Damman et al. J Am Coll Cardiol. .
Free article

Abstract

Objectives: We present the 5-year clinical outcomes according to treatment strategy with additional risk stratification of the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial.

Background: Long-term outcomes may be relevant to decide treatment strategy for patients presenting with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and elevated troponin T.

Methods: We randomly assigned 1,200 patients to an early invasive or selective invasive strategy. The outcomes were the composite of death or myocardial infarction (MI) and its individual components. Risk stratification was performed with the FRISC (Fast Revascularization in InStability in Coronary artery disease) risk score.

Results: At 5-year follow-up, revascularization rates were 81% in the early invasive and 60% in the selective invasive group. Cumulative death or MI rates were 22.3% and 18.1%, respectively (hazard ratio [HR]: 1.29, 95% confidence interval [CI]: 1.00 to 1.66, p = 0.053). No difference was observed in mortality (HR: 1.13, 95% CI: 0.80 to 1.60, p = 0.49) or MI (HR: 1.24, 95% CI: 0.90 to 1.70, p = 0.20). After risk stratification, no benefit of an early invasive strategy was observed in reducing death or spontaneous MI in any of the risk groups.

Conclusions: In patients presenting with NSTE-ACS and elevated troponin T, we could not demonstrate a long-term benefit of an early invasive strategy in reducing death or MI. (Invasive versus Conservative Treatment in Unstable coronary Syndromes [ICTUS]; ISRCTN82153174).

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Comment in

  • Having it both ways.
    Bittl JA, Maron DJ. Bittl JA, et al. J Am Coll Cardiol. 2010 Mar 2;55(9):865-6. doi: 10.1016/j.jacc.2009.11.027. Epub 2010 Jan 4. J Am Coll Cardiol. 2010. PMID: 20045277 No abstract available.

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