Abstract 15984: Optimal Timing of Invasive Angiography in Non-ST-Elevation Myocardial Infarction — The Leipzig Immediate versus Early and Late PercutaneouS Coronary Intervention triAl in NSTEMI (LIPSIA-NSTEMI Trial)
Background: For patients with NSTEMI an early invasive approach is recommended <72 h. This recommendation is challenged by recently published selective invasive trials. Furthermore, the optimal timing of intervention remains uncertain. Aim of this multicenter trial was to assess whether an immediate invasive approach is superior to an early invasive or a selective invasive approach with respect to reduction of myocardial infarction.
Methods: Patients with NSTEMI (last symptoms <24 h) were randomized to either an immediate invasive (group A: <2 h after randomization; n=201), an early invasive (group B: 12–48 h after randomization; n=201) or a selective invasive approach (group C) with a high invasive percentage among this group (n=201). The primary endpoint was the peak creatine kinase-MB value during index hospitalization; key secondary clinical endpoints were the composite of 1) death and myocardial infarction; 2) death, infarction, and rehospitalization for unstable angina; 3) death, infarction, rehospitalization for unstable angina and refractory ischemia <6 months after randomization. Safety was assessed by major bleeding.
Results: All high-risk patients (median GRACE-score 140) were treated by ASA, 600 mg clopidogrel loading plus high-dose tirofiban. Median time from randomization to sheath insertion was 1.1 h in group A versus 18.6 h in group B and 67.2 h in group C (86% invasive angiography) (p<0.001). There was no difference in the peak creatine kinase-MB values (nor in the area under the curve) in any of the groups. The key secondary clinical endpoints were not different between the 3 study groups: death + infarction: 23.9% vs 20.0% vs 19.4% p=0.53; respectively; death, infarction, and rehospitalization for unstable angina: 28.4% vs 25.0% vs 22.9% p=0.45; death, infarction, rehospitalization for unstable angina and refractory ischemia: 28.9% vs 30.0% vs 27.9% p=0.89. All other endpoints including bleeding complications did not differ between the groups.
Conclusions: In NSTEMI an immediate invasive approach does not offer an advantage over an early or selective invasive approach with respect to myocardial infarction as defined by peak creatine kinase-MB levels which is supported by similar clinical outcomes between the groups.
- © 2010 by American Heart Association, Inc.