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, Alexander Hirsch, Fons Windhausen, Jan G.P. Tijssen, Robbert J. de Winter*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

110 Citations (Scopus)

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).

Original languageEnglish
Pages (from-to)858-864
Number of pages7
JournalJournal of the American College of Cardiology
Volume55
Issue number9
DOIs
Publication statusPublished - 2 Mar 2010
Externally publishedYes

Bibliographical note

Funding Information:
The ICTUS study was supported by the Interuniversitary Cardiology Institute of the Netherlands (ICIN), the Working Group on Cardiovascular Research of the Netherlands (WCN), and educational grants from Eli Lilly , Sanofi/Synthelabo , Sanofi-Aventis , Pfizer , and Medtronic . Roche Diagnostics, the Netherlands, kindly provided the reagents for Core Laboratory cardiac troponin T measurements.

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