Title :

Optimal Timing of Intervention in NSTE-ACS Without Pre -Treatment The EARLY Randomized Trial

Author(s) :

Lemesle, Gilles [Auteur]
Alliance française pour les essais cliniques cardio-vasculaires - French Alliance for Cardiovascular Trials [FACT]
Faculté de Médecine Henri Warembourg - Université de Lille
Institut Coeur Poumon [CHU Lille]
Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U 1011 [RNMCD]
Laine, Marc [Auteur]
Mediterranean Association for Research and Studies in Cardiology [MARS cardio]
Assistance Publique - Hôpitaux de Marseille [APHM]
Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research [C2VN]
Pankert, Mathieu [Auteur]
Centre Hospitalier Henri Duffaut (Avignon)
Boueri, Ziad [Auteur]
Motreff, Pascal [Auteur]
CHU Clermont-Ferrand
Paganelli, Franck [Auteur]
Mediterranean Association for Research and Studies in Cardiology [MARS cardio]
Assistance Publique - Hôpitaux de Marseille [APHM]
Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research [C2VN]
Baumstarck, Karine [Auteur]
Centre d'études et de recherche sur les services de santé et la qualité de vie [CEReSS]
Roch, Antoine [Auteur]
Hôpital Nord [CHU - APHM]
Kerbaul, Francois [Auteur]
Dysoxie, suractivité : aspects cellulaires et intégratifs thérapeutiques [DS-ACI / UMR MD2]
Puymirat, Etienne [Auteur]
Paris-Centre de Recherche Cardiovasculaire [PARCC (UMR_S 970/ U970)]
Bonello, Laurent [Auteur correspondant]
Mediterranean Association for Research and Studies in Cardiology [MARS cardio]
Assistance Publique - Hôpitaux de Marseille [APHM]
Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research [C2VN]

Journal title :

JACC: Cardiovascular Interventions

Pages :

907-917

Publisher :

Elsevier/American College of Cardiology

Publication date :

2020-04-27

ISSN :

1936-8798

English keyword(s) :

non–ST-segment elevation acute coronary syndrome
outcome
percutaneous coronary intervention
pre-treatment
timing

HAL domain(s) :

Sciences du Vivant [q-bio]/Médecine humaine et pathologie/Cardiologie et système cardiovasculaire

English abstract : [en]

ObjectivesThe aim of this study was to compare a delayed and a very early invasive strategy in patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS) without pre-treatment.BackgroundThe optimal delay ...
Show more >ObjectivesThe aim of this study was to compare a delayed and a very early invasive strategy in patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS) without pre-treatment.BackgroundThe optimal delay of the invasive strategy in patients with NSTE-ACS remains debated and has never been investigated in patients not pre-treated with P2Y12–adenosine diphosphate receptor antagonists.MethodsA prospective, open-label, randomized controlled trial was conducted. Altogether, 741 patients presenting with intermediate- or high-risk NSTE-ACS intended for an invasive strategy were included. The modified intention-to-treat analysis was composed of 709 patients after 32 withdrew consent. Patients were randomized 1:1 to the delayed invasive group (DG) (n = 363) with coronary angiography (CA) performed 12 to 72 h after randomization or the very early invasive group (EG) (n = 346) with CA within 2 h. No pre-treatment with a loading dose of a P2Y12–adenosine diphosphate receptor antagonist was allowed before CA. The primary endpoint was the composite of cardiovascular death and recurrent ischemic events at 1 month, as determined by a blinded adjudication committee.ResultsMost patients had high-risk NSTE-ACS in both groups (93% in the EG vs. 92.5% in the DG). The median time between randomization and CA was 0 h (interquartile range [IQR]: 0 to 1 h) in the EG group and 18 h (IQR: 11 to 23 h) in the DG. The primary endpoint rate was significantly lower in the EG (4.4% vs. 21.3% in the DG; hazard ratio: 0.20; 95% confidence interval: 0.11 to 0.34; p < 0.001), driven by a reduction in recurrent ischemic events (19.8% vs. 2.9%; p < 0.001). No difference was observed for cardiovascular death.ConclusionsWithout pre-treatment, a very early invasive strategy was associated with a significant reduction in ischemic events at the time of percutaneous coronary intervention in patients with intermediate- and high-risk NSTE-ACS. (Early or Delayed Revascularization for Intermediate and High-Risk Non ST-Elevation Acute Coronary Syndromes; NCT02750579)Show less >

Language :

Anglais

Peer reviewed article :

Oui

Audience :

Internationale

Popular science :

Non

Collections :

• Récepteurs nucléaires, Maladies Cardiovasculaires et Diabète (RNMCD) - U1011

Source :

Harvested from HAL