Abstract 13377: Optimal Timing of Invasive Angiography in NSTEMI (LIPSIA-NSTEMI Trial)
Background: The optimal timing of intervention in non-ST-elevation myocardial infarction (NSTEMI) 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 large infarction.
Methods and results: Patients with NSTEMI were randomized to either an immediate (<2 h after randomization; n=201), an early (10-48 h after randomization; n=200) or a selective invasive approach with high invasive percentage (n=201). The primary endpoint was the peak CK-MB activity during index hospitalization; key secondary clinical endpoints were the composite of 1) death and non-fatal infarction; 2) death, non-fatal infarction, and refractory ischemia; 3) death, non-fatal infarction, refractory ischemia, and rehospitalization for unstable angina within 6 months. The median time from randomization to angiography was 1.1 h in the immediate versus 18.6 h in the early and 67.2 h in the selective invasive group (p<0.001). There was no significant difference in the peak CK-MB activity between groups and also no difference for any of the predefined subgroups such as GRACE-score <median vs ≥median, diabetes, gender, or age < 65 vs ≥65. The key secondary clinical endpoints were similar between groups at 6 month follow-up: death and infarction: 21.0% versus 16.0% versus 14.5%; p=0.17; death, infarction, refractory ischemia: 20.9% versus 21.5% versus 22.0%; p=0.98; death, infarction, refractory ischemia, rehospitalization: 26.0% versus 26.5% versus 24.5%; p=0.91; respectively.
Conclusions: In NSTEMI patients an immediate invasive approach does not offer an advantage over an early or a selective invasive approach with respect to myocardial infarction as defined by peak CK-MB levels which is supported by similar clinical outcomes.
- © 2011 by American Heart Association, Inc.