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Early Angiography Benefits High-Risk Coronary Patients

Intervention reduces risk of death, MI and stroke within six months for high-risk patients

WEDNESDAY, May 20 (HealthDay News) -- For high-risk patients with acute coronary syndrome, coronary angiography within hours after presentation can reduce the chance of subsequent death, heart attack and stroke, according to a study in the May 21 issue of the New England Journal of Medicine.

Shamir R. Mehta, M.D., of McMaster University in Hamilton, Canada, and colleagues randomly assigned 3,031 patients with acute coronary syndrome to receive coronary angiography early (≤ 24 hours after randomization) or delayed (≥ 36 hours after randomization). The primary outcome was a composite of death, heart attack and stroke within six months; the secondary outcome was a composite of death, heart attack and refractory ischemia within six months.

The researchers found that in the early intervention group (angiography within a median 14 hours), the primary outcome occurred in 9.6 percent of patients at six months, compared with 11.3 percent in the delayed-intervention group (angiography within a median 50 hours). For the secondary outcome, the early intervention group had a 28 percent relative reduction compared to 12.9 percent for the delayed-intervention group. The authors note that the third of patients at highest risk improved for the primary outcome (hazard ratio, 0.65), but the two thirds with intermediate and low risk did not (hazard ratio, 1.12).

"Early intervention did not differ greatly from delayed intervention in preventing the primary outcome, but it did reduce the rate of composite secondary outcome of death, myocardial infarction, or refractory ischemia and was superior to delayed intervention in high-risk patients," the authors write.

Several of the study authors reported receiving lecture fees, consulting fees and grant support from multiple companies in the pharmaceutical industry.

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