In a nutshell
This study investigated if early intervention in acute coronary syndrome (ACS) improves clinical outcomes (COs).
They found that early intervention does not have an effect on long-term COs in ACS.
Some background
Coronary artery disease (CAD) is used to describe heart conditions caused by reduced blood flow. Acute coronary syndrome (ACS) is a short-term but serious CAD event. ACS is caused by a sudden block of blood flow. Restoring blood flow is important in ACS. The first step of treatment is assessing how severe ACS is. An electrocardiogram (ECG) measures the wave pattern of the heart. Elevation in the ‘ST’ segment of the graph means it is a severe heart attack.
To restore blood flow, patients undergo a surgical procedure. This involves visualizing the blockage using invasive coronary angiography (ICA). When the blockage is located, it is removed in a procedure called revascularisation (RVS). The timing of ICA-RVS is not clear. Current guidelines recommend intervention within 24 hours. Some studies suggest intervention within 12 hours is more successful long-term.
Methods & findings
This study included 2147 patients with non-ST elevation ACS (NST-ACS). Patients were randomly assigned to undergo early ICA-RVS (up to 12 hours) or standard ICA-RVS. Follow-up was performed on average 4.3 years after the procedure.
The rates of death or recurrent heart attack were similar in both groups. There was no difference in the rates of hospitalization for heart failure. There was a short-term benefit of early ICA-RVS. It was associated with reduced risk of non-fatal heart attack, 15 days after the procedure.
The bottom line
The authors concluded that early intervention does not have an effect on long-term COs in ACS.
The fine print
The recruitment of patients to studies like this can be difficult. As the condition is acute, some eligible patients may not have been included. More investigation is needed to determine if early intervention improves clinical outcomes.
What’s next?
If you have any concerns regarding CAD treatment, please consult with your physician.
Published By :
Circulation
Date :
Dec 18, 2018
