Outcomes Similar for Coronary Syndrome Treatments

Invasive and more conservative treatment produce similar morbidity, mortality after long-term follow-up

FRIDAY, March 9 (HealthDay News) -- A long-term follow-up of patients with non-ST-elevation acute coronary syndrome (nSTE-ACS) has shown that an early invasive treatment strategy or a more conservative selective treatment strategy are similar in terms of morbidity and mortality, according to a study in the March 10 issue of The Lancet.

Robbert J. de Winter, M.D., from the Academic Medical Centre in Amsterdam, the Netherlands, and colleagues performed a long-term follow-up of a study that had compared outcomes in 1,200 patients with nSTE-ACS who had been randomized to an early invasive strategy or a selective treatment strategy. The early invasive strategy involved early routine catheterization and revascularization if needed, while the selective treatment strategy involved catheterization only if the patient had refractory angina or recurrent ischemia.

The researchers found that after four years, there were no differences between the early invasive and selective treatment groups in the rate of all-cause or cardiovascular mortality. After three years, both groups were similar in terms of the combined rate for death, recurrent myocardial infarction, or rehospitalization for anginal symptoms. The rates of death or spontaneous myocardial infarction were also similar in the two groups after three years. There were significantly more myocardial infarctions in the early invasive strategy group after three years (hazard ratio 1.61).

"Long-term follow-up…suggests that an early invasive strategy might not be better than a more selective invasive strategy in patients with nSTE-ACS and an elevated cardiac troponin, and implementation of either strategy might be acceptable in these patients," de Winter and colleagues conclude.

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