Abstract 16711: Timing of Angiography in Non-ST-elevation Acute Coronary Syndromes and the Effect on Cardiovascular Mortality and Myocardial Infarction.
Background: With the exception of indications for emergency angiography and revascularization, controversy remains about the optimal timing of angiography in patients presenting with non-ST-elevation acute coronary syndrome (nSTE-ACS). We undertook a collaborative analysis of data from the FRISC-II, ICTUS and RITA-3 trials to assess the effect of timing of angiography on long-term clinical outcomes.
Methods: The 3 trials provided data on 2433 patients with known angiography data. All patients were originally randomized to the routine invasive strategy. We used a landmark method to investigate the relation between timing of angiography and outcomes. One-day interval landmarks were used, ranging from 1 to 7 days. Each landmark was used as a new baseline, and the main composite outcome cardiovascular death or myocardial infarction (MI) was followed up to 5 years. At each landmark, we compared patients who received angiography with patients who received angiography within the landmark with patients who received angiography at a later time or none at all. Patients who had an event prior to each landmark were excluded. Hazard ratios were obtained with Cox regression models, adjusted for established predictors of the main outcome and a variable indicating the original trial. A P<0.01 was deemed significant.
Results: Figure 1 shows hazard ratios (with 99% confidence intervals) for cardiovascular death or MI, comparing angiography within the landmark with angiography at a later time or none at all. Angiography within none of the landmarks was associated with significantly lower cardiovascular death or MI.
Conclusions: In the pooled dataset of patients undergoing a routine invasive strategy for nSTE-ACS, the timing of angiography is not related to cardiovascular death or MI.
- © 2010 by American Heart Association, Inc.