Vroeg invasieve behandelstrategie niet beter dan selectief invasieve bij patiënten met een acuut coronair syndroom zonder ST-elevatie en met een verhoogde troponinewaarde: Langetermijnresultaten van de ICTUS-studie

Translated title of the contribution: 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

F. Windhausen, A. Hirsch, J. G.P. Tijssen, F. W.A. Verheugt, J. H. Cornel, R. J. De Winter*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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.

Translated title of the contributionEarly 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
Original languageDutch
Pages (from-to)437-444
Number of pages8
JournalNederlands Tijdschrift voor Geneeskunde
Volume152
Issue number8
Publication statusPublished - 25 Feb 2008

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