January 09, 2017
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Early invasive treatment strategy for high-risk non-STEMI reduces risk for ischemic events

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NEW ORLEANS — Patients with high-risk non-STEMI undergoing coronary angiography within 12 hours of their first electrocardiogram demonstrated reduced risk for myocardial infarction and death at 6 months compared with patients who underwent CAG at 24 to 72 hours, according to findings presented at the American Heart Association Scientific Sessions.

Using data from the TAO trial, Pierre Deharo, MD, of the Bristol Heart Institute in England, and colleagues conducted an analysis of 4,071 patients who underwent CAG at various time intervals to determine the impact of “very early,” early and standard timeframes in patients hospitalized for non-STEMI who had a GRACE score greater than 140.

The researchers defined “very early” CAG (n = 1,648) as 12 hours or less after first ECG, early CAG as 12 to 24 hours (n = 1,420) and standard as 24 to 72 hours (n = 1,003).

“Immediate strategies have been tested and did not show any superiority yet, maybe because the patient needs [some] time for the antiplatelet agents to take effect, but we don’t really know,” Deharo said during the presentation to clarify why the research team decided on the “very early” threshold of 12 hours or less.

Using the standard CAG timeframe as a reference, CAG from 12 to 24 hours was not associated with a reduction of all-cause death and MI at 180 days (adjusted OR = 0.95; 95% CI, 0.73-1.22). However, CAG at 12 hours or less was associated with a reduced risk for all-cause death and MI at 180 days (aOR = 0.73; 95% CI, 0.57-0.94).

“This strategy would allow [for] a very early diagnostic, a very early risk stratification, treatment adaptation, and probably very early discharge,” Deharo said.

Deharo acknowledged that this was an observational study from a post-hoc analysis of a randomized trial and said their finding deserves a prospective randomized trial that, “if confirmed, these results [could] have potential implications for the organization of care.” – by Ryan McDonald

Reference: Deharo P, et al. IN.AOS.855 - Hot Trials in Interventional Cardiology. Presented at: American Heart Association Scientific Sessions; Nov. 12-16, 2016; New Orleans.

Disclosure: Deharo reports no relevant financial disclosures.