Abstract 4510: Long-term Clinical Outcomes of an Early Invasive Strategy Compared With a Conservative Strategy for Non-ST-Elevation Acute Coronary Syndromes: A Collaborative Analysis of Individual Patient Data From the FRISC-II, ICTUS, RITA-3 Trials
Background: Current guidelines for patients with high-risk Non-ST-Elevation Acute Coronary Syndromes (NSTE-ACS) recommend an early invasive strategy. The FRISC II, ICTUS, and RITA-3 trials compared this strategy with a conservative strategy, with variable long-term outcomes. We present the pooled 5-year outcomes on cardiovascular death or MI.
Methods: We pooled individual patient data of 5467 patients presenting with NSTE-ACS, randomized to an early invasive strategy, consisting of early routine catheterization and subsequent revascularization if appropriate, or a selective invasive strategy, consisting of ischemia guided catheterization. The main composite endpoint was cardiovascular death or MI at 5 years after randomization. Cumulative event rates were obtained with the Kaplan-Meier method. Hazard ratios were obtained with Cox proportional hazards models. Risk stratification was performed based on baseline-risk according to the GRACE risk score.
Results: The 3 trials provided data on 5467 patients. At 5 years, the cumulative event rate of cardiovascular death or MI was 14.8% in the early invasive strategy and 17.8% in the conservative strategy (HR 0.82, 95% CI: 0.71– 0.93, <0.01). Stratified by the GRACE risk score, the early invasive strategy improved the composite outcome in the third of patients who where at the highest risk (HR 0.77, 95% CI: 0.64 – 0.94, p=0.01), but not in the two thirds at low (HR 0.82, 95% CI: 0.63–1.07, p=0.13) to intermediate risk (HR 0.88, 95% CI: 0.68 –1.14, p=0.34) (Figure 1⇓).
Conclusion: In patients with high-risk NSTE-ACS, a long-term benefit of an early invasive strategy was observed in risk of cardiovascular death or spontaneous MI.