Pierre Deharo1,2, Gregory Ducrocq3,4,5, Christoph Bode6, Marc Cohen7, Thomas Cuisset1, Shamir R Mehta8, Charles Pollack9, Stephen D Wiviott10, Yedid Elbez3,4,5, Marc S Sabatine10, Philippe Gabriel Steg11,4,5,12,13. 1. Hopital La Timone, Marseille, France (P.D., T.C.). 2. Bristol Heart Institute, United Kingdom (P.D.). 3. Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, France (G.D., Y.E., P.G.S.). 4. Département Hospitalo-Universitaire FIRE, INSERM U-1148, Paris, France (G.D., Y.E., P.G.S.). 5. FACT (French Alliance for Cardiovascular Clinical Trials), an F-CRIN network, INSERM U-1148, Paris, France (G.D., Y.E., P.G.S.). 6. Heart Center Freiburg University, Cardiology and Angiology I, Faculty of Medicine, Germany (C.B.). 7. Newark Beth Israel Medical Center, Rutgers-New Jersey Medical School, Newark (M.C.). 8. McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (S.R.M.). 9. Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA (C.P.). 10. TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.W., M.S.S.). 11. Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, France (G.D., Y.E., P.G.S.). gabriel.steg@aphp.fr. 12. Université Paris Diderot, Sorbonne-Paris Cité, France (P.G.S.). 13. NHLI, Royal Brompton Hospital, Imperial College, London, United Kingdom (P.G.S.).
Abstract
BACKGROUND: In patients with non-ST-segment-elevation myocardial infarction (NSTEMI) and GRACE (Global Registry of Acute Coronary Events) score >140, coronary angiography (CAG) is recommended by European and American guidelines within 24 hours. We sought to study the association of very early (ie, ≤12 hours), early (12-24 hours), and delayed (>24 hours) CAG in patients with NSTEMI with GRACE score >140 with ischemic outcomes. METHODS: The TAO trial (Treatment of Acute Coronary Syndrome With Otamixaban) randomized patients with NSTEMI and CAG scheduled within 72 hours toheparin plus eptifibatide versus otamixaban. In this post hoc analysis, patients with a GRACE score >140 were categorized into 3 groups according to timing of CAG from admission (<12, ≥12-<24, and ≥24 hours). The primary ischemic outcome was the composite of all-cause death and myocardial infarction within 180 days of randomization. RESULTS:CAG was performed in 4071 patients (<12 hours, n=1648 [40.5%]; 12-24 hours, n=1420 [34.9%]; ≥24 hours, n=1003 [24.6%]). With CAG ≥24 hours as a reference, CAG from 12 to 24 hours was not associated with a lower risk of primary ischemic outcome at 180 days (odds ratio, 0.96; 95% confidence interval, 0.75-1.23), whereas CAG <12 hours was associated with a lower risk of death and myocardial infarction (odds ratio, 0.71; 95% confidence interval, 0.55-0.91). Performing CAG <12 hours was also associated with a lower risk of death and myocardial infarction (odds ratio, 0.76; 95% confidence interval, 0.61-0.94; P=0.01) compared with CAG performed at 12 to 24 hours. No difference was observed in bleeding complications. CONCLUSIONS: In patients with high-risk NSTEMI, undergoing CAG within the initial 12 hours after admission (as opposed to later, either 12-24 or ≥24 hours) was associated with lower risk of ischemic outcomes at 180 days.
RCT Entities:
BACKGROUND: In patients with non-ST-segment-elevation myocardial infarction (NSTEMI) and GRACE (Global Registry of Acute Coronary Events) score >140, coronary angiography (CAG) is recommended by European and American guidelines within 24 hours. We sought to study the association of very early (ie, ≤12 hours), early (12-24 hours), and delayed (>24 hours) CAG in patients with NSTEMI with GRACE score >140 with ischemic outcomes. METHODS: The TAO trial (Treatment of Acute Coronary Syndrome With Otamixaban) randomized patients with NSTEMI and CAG scheduled within 72 hours to heparin plus eptifibatide versus otamixaban. In this post hoc analysis, patients with a GRACE score >140 were categorized into 3 groups according to timing of CAG from admission (<12, ≥12-<24, and ≥24 hours). The primary ischemic outcome was the composite of all-cause death and myocardial infarction within 180 days of randomization. RESULTS: CAG was performed in 4071 patients (<12 hours, n=1648 [40.5%]; 12-24 hours, n=1420 [34.9%]; ≥24 hours, n=1003 [24.6%]). With CAG ≥24 hours as a reference, CAG from 12 to 24 hours was not associated with a lower risk of primary ischemic outcome at 180 days (odds ratio, 0.96; 95% confidence interval, 0.75-1.23), whereas CAG <12 hours was associated with a lower risk of death and myocardial infarction (odds ratio, 0.71; 95% confidence interval, 0.55-0.91). Performing CAG <12 hours was also associated with a lower risk of death and myocardial infarction (odds ratio, 0.76; 95% confidence interval, 0.61-0.94; P=0.01) compared with CAG performed at 12 to 24 hours. No difference was observed in bleeding complications. CONCLUSIONS: In patients with high-risk NSTEMI, undergoing CAG within the initial 12 hours after admission (as opposed to later, either 12-24 or ≥24 hours) was associated with lower risk of ischemic outcomes at 180 days.
Authors: Chris Wilkinson; Owen Bebb; Tatendashe B Dondo; Theresa Munyombwe; Barbara Casadei; Sarah Clarke; François Schiele; Adam Timmis; Marlous Hall; Chris P Gale Journal: Heart Date: 2018-11-23 Impact factor: 5.994
Authors: Hwan Song; Hyo Joon Kim; Kyu Nam Park; Soo Hyun Kim; Won Young Kim; Byung Kook Lee; In Soo Cho; Jae Hoon Lee; Chun Song Youn Journal: J Clin Med Date: 2021-01-23 Impact factor: 4.241
Authors: Charles V Pollack; W Frank Peacock; Durgesh D Bhandary; Steven H Silber; Narinder Bhalla; Sunil V Rao; Deborah B Diercks; Alex Frost; Sripal Bangalore; John F Heitner; Charles Johnson; Renato DeRita; Naeem D Khan Journal: Crit Pathw Cardiol Date: 2020-12