In patients with acute myocardial infarction without ST-segment elevation on ECG (non-STEMI), previous studies have indicated that routine invasive treatment confers more benefit as compared to selective invasive approach. The benefits of routine invasive coronary intervention have been the most evident in patients with higher baseline risk profile. However, the question of optimal timing of routine invasive intervention remains unsolved. Immediate invasive intervention early after admission for non-STEMI may limit myocardial necrosis by securing the patency of the culprit coronary artery. Nevertheless, several previous studies reported higher levels of biomarkers of myocardial injury in patients undergoing early PCI. The question of earlier versus delayed procedure in non-STEMI patients may thus amount to whether the risk of intervening on an unstable plaque is greater than the risk of new ischemic events while waiting for the invasive procedure. The purpose of the present study is to compare effects of immediate coronary intervention, within 2 hours of admission, versus delayed intervention, within 2-72 hours after admission, in patients witn non-STEMI.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
323
Invasive coronary angiography followed by either percutaneous coronary intervention (PCI) and/or coronary artery bypass graft (CABG) surgery as soon as possible and/or within 2 hours of admission
Invasive coronary angiography followed by either percutaneous coronary intervention (PCI) and/or coronary artery bypass graft (CABG) surgery during the hospitalization and/or within 2-72 hours of admission
Implantation of coronary stents
Clinical Centre of Serbia, Department of Cardiology
Belgrade, Serbia
Composite of all-cause death or myocardial reinfarction
Time frame: within 30 days of randomization
Composite of all-cause death, myocardial reinfarction or recurrent ischemia
Time frame: within 30 days of randomization
All-cause mortality
Time frame: within 30 days, 1, 3 and 5 years after randomization
Myocardial reinfarction
Time frame: within 30 days, 1, 3 and 5 years after randomization
Stroke
Time frame: within 30 days, 1, 3 and 5 years after randomization
Recurrent ischemia
Time frame: within 30 days of randomization
Major bleeding
Time frame: within 30 days, 1, 3 and 5 years after randomization
Duration of index hospitalization
Time frame: at 30-day follow-up, the duration of hospital stay is assessed
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