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Early and Selective Invasive Heart Strategies Compared

ICTUS study finds no benefit to early invasive strategy in reducing deaths, myocardial infarction

MONDAY, Jan. 4 (HealthDay News) -- An early invasive revascularization strategy for patients who present with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and elevated troponin T does not have any benefit over a selective invasive strategy that starts with medical stabilization in reducing death or myocardial infarction, according to a study published online Dec. 30 in the Journal of the American College of Cardiology.

Peter Damman, M.D., of the University of Amsterdam in the Netherlands, and colleagues participating in the Invasive Versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) study randomized 1,200 patients with NSTE-ACS and elevated troponin T to either an early invasive strategy (early coronary angiography and revascularization) or a selective invasive strategy (medical stabilization, angiography and revascularization for refractory angina or other conditions). The groups were followed for five years for a composite of death and myocardial infarction.

At the end of the study period, the researchers found the rates of revascularization to be 81 and 60 percent in the early invasive and selective invasive groups, respectively. The composite death or myocardial infarction rates were 22.3 and 18.1 percent, respectively, with no significant mortality difference between the strategies. After stratifying the subjects for risk, the researchers discerned no benefit to the early invasive strategy for reducing death or spontaneous myocardial infarction in any of the risk groups.

"Although many may prefer an early invasive strategy in patients with NSTE-ACS and high-risk features, a selective invasive strategy may be an attractive alternative in medically stabilized patients," the authors write.

The ICTUS study was supported in part by educational grants from Eli Lilly, Sanofi/Synthelabo, Sanofi-Aventis, Pfizer and Medtronic. Roche Diagnostics provided reagents for cardiac troponin T measurements.

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