Abstract 17886: Impact of a Very Early Invasive Strategy in High Risk NSTEMI: Analysis From the TAO (Treatment for Acute Coronary Syndromes With Otamixaban) Trial
Introduction: In patients with NSTEMI and GRACE score > 140, coronary angiography (CAG) with a view to revascularization is recommended within 24h. Whether further reducing time to CAG is beneficial in this population remains unclear.
Hypothesis: We sought to compare the impact of a “very early” (i.e. within 12 hours after admission), early (12-24h) and standard (>24h) CAG in patients hospitalized for NSTEMI and with GRACE score >140.
Methods: The TAO trial randomized individuals with moderate to high-risk NSTEMI and CAG scheduled within the first 72 hours to heparin plus eptifibatide versus otamixaban. Otamixaban did not reduce the rate of ischemic events but did increase bleeding. Patients with GRACE score > 140 and undergoing CAG were stratified in 3 groups according to timing of CAG from the first ECG performed on admission (≤12h, 12 to 24h, >24h). The primary outcome was defined by the composite of all-cause death and MI at 180 days. Analyses were adjusted on age, gender, diabetes mellitus, prior PCI, creatinine, systolic blood pressure, elevated biomarker at presentation and heart failure.
Results: CAG was performed in 4,071 patients (≤12h n=1648 (40.5%), 12 to 24h n=1420 (34.9%), >24h n=1003 (24.6%)). With CAG > 24h as a reference, CAG from 12 to 24 hours was not associated with a reduction of the primary outcome (OR 0.95, 95% CI 0.73-1.22) whereas CAG ≤ 12h was associated with a lower risk of death and MI (OR 0.73, 95% CI 0.57-0.94) (figure1A). Performing CAG ≤ 12h was also associated with a lower risk of the primary endpoint (OR 0.79, 95%IC 0.64-0.99; p=0.04) compared to CAG performed 12 to 24 hours after admission (figure1B).
Conclusions: In patients with high-risk NSTEMI, undergoing CAG within the initial 12hours (as opposed to between 12 and 24 h or > 24 h after admission) was associated with a lower risk of ischemic outcomes at 180 days. This observation deserves prospective confirmation and has potentially implications for organization of care.
Author Disclosures: P. Deharo: None. G. Ducrocq: None. C. Bode: None. M. Cohen: Other Research Support; Significant; sanofi. T. Cuisset: None. S. Mehta: Research Grant; Significant; Astrazeneca and Boston Scientific. C. Pollack: Other Research Support; Modest; Daiichi-Sankyo. Other Research Support; Significant; Sanofi, AstraZeneca. Boehringer Ingelheim, Janssen, BMS/Pfizer. S. Wiviott: Other Research Support; Significant; Sanofi Aventis, AstraZeneca, Merck, Eli Lilly/Daiichi Sankyo, Boehringer Ingelheim. Y. Elbez: None. M. Sabatine: Research Grant; Significant; Abbott Laboratories; Amgen; AstraZeneca; Critical Diagnostics; Daiichi-Sankyo; Eisai; Gilead; GlaxoSmithKline; Intarcia; MedImmune; Merck; Novartis; Poxel; Roche Diagnostics; Sanofi-aventis; Takeda. Honoraria; Modest; Alnylam; AstraZeneca; CVS Caremark; Ionis; Merck. P. Steg: Research Grant; Significant; Sanofi, Servier, Merck. Consultant/Advisory Board; Modest; Amarin, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, CSL-Behring, Daiichi-Sankyo, GlaxoSmithKline, Lilly, Merck, Janssen, Novartis, Pfizer, The Medicines Company, Regeneron, Roche, The Medicines Company. Consultant/Advisory Board; Significant; Zeneca, Sanofi, Servier.
- © 2016 by American Heart Association, Inc.