Early invasive versus non-invasive treatment in patients with non-ST-elevation acute coronary syndrome (FRISC-II): 15 year follow-up of a prospective, randomised, multicentre study

Objective: This study aimed to evaluate the clinical significance and safety of optical coherence tomography (OCT) in patients with non-ST-elevation acute coronary syndrome (NSTEACS) combined with intermediate lesions.Methods: Sixty-five NSTEACS patients with intermediate lesions confirmed with coronary angiography at our department were included in this study. Among them, 33 patients received only standardized drug treatment (drug group) and the other 32 patients received percutaneous coronary intervention (PCI) according to the OCT examination based on drug treatment (OCT group). Major adverse cardiovascular events (MACEs), revascularization, success rate of OCT examination, related complications, and other patient situations in the two groups during hospitalization and the 12-month follow-up period were compared.Results: No death or stroke occurred in either group during hospitalization and follow-up. In the drug treatment group, six patients experienced frequent angina, and five patients with acute myocardial infarction were rehospitalized and underwent PCI procedures. In the OCT group, although two patients underwent repeat revascularization, no additional acute myocardial infarction events occurred. There was a statistically significant difference between the two groups (P < .01). All patients in the OCT group successfully completed the related vessel examination, and 24 patients underwent PCI procedures because of unstable plaque diagnosed with OCT.Conclusion: OCT-guided PCI is safe and effective for the treatment of patients with NSTEACS combined with intermediate lesions.

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Early invasive versus non-invasive assessment in patients with suspected non-ST-elevation acute coronary syndrome

Heart ◽

10.1136/heartjnl-2020-318778 ◽

2021 ◽

pp. heartjnl-2020-318778

Author(s):

Thomas A Kite ◽

Andrew Ladwiniec ◽

J Ranjit Arnold ◽

Gerry P McCann ◽

Alastair J Moss

Keyword(s):

Acute Coronary Syndrome ◽

High Risk ◽

Invasive Coronary Angiography ◽

Standard Of Care ◽

Optimal Timing ◽

Invasive Strategy ◽

Coronary Syndrome ◽

Non Invasive ◽

St Elevation ◽

Elevation Acute Coronary Syndrome

Non-ST-elevation acute coronary syndrome (NSTE-ACS) comprises a broad spectrum of disease ranging from unstable angina to myocardial infarction. International guidelines recommend a routine invasive strategy for managing patients with NSTE-ACS at high to very high-risk, supported by evidence of improved composite ischaemic outcomes as compared with a selective invasive strategy. However, accurate diagnosis of NSTE-ACS in the acute setting is challenging due to the spectrum of non-coronary disease that can manifest with similar symptoms. Heterogeneous clinical presentations and limited uptake of risk prediction tools can confound physician decision-making regarding the use and timing of invasive coronary angiography (ICA). Large proportions of patients with suspected NSTE-ACS do not require revascularisation but may unnecessarily undergo ICA with its attendant risks and associated costs. Advances in coronary CT angiography and cardiac MRI have prompted evaluation of whether non-invasive strategies may improve patient selection, or whether tailored approaches are better suited to specific subgroups. Future directions include (1) better understanding of risk stratification as a guide to investigation and therapy in suspected NSTE-ACS, (2) randomised clinical trials of non-invasive imaging versus standard of care approaches prior to ICA and (3) defining the optimal timing of very early ICA in high-risk NSTE-ACS.

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54 Frail older patients have a greater improvement in physical quality of life than robust patients at one year following invasive treatment for non-st elevation acute coronary syndrome

Heart ◽

10.1136/heartjnl-2017-311726.53 ◽

2017 ◽

Vol 103 (Suppl 5) ◽

pp. A42-A43 ◽

Cited By ~ 1

Author(s):

Hannah Sinclair ◽

Sophie Zhaotao Gu ◽

Jonathan Batty ◽

Benjamin Beska ◽

Murugapathy Verrasamy ◽

...

Keyword(s):

Quality Of Life ◽

Acute Coronary Syndrome ◽

Older Patients ◽

Invasive Treatment ◽

Physical Quality ◽

Coronary Syndrome ◽

St Elevation ◽

Elevation Acute Coronary Syndrome ◽

One Year

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Growth Differentiation Factor 15 for Risk Stratification and Selection of an Invasive Treatment Strategy in Non–ST-Elevation Acute Coronary Syndrome

Circulation ◽

10.1161/circulationaha.107.697714 ◽

2007 ◽

Vol 116 (14) ◽

pp. 1540-1548 ◽

Cited By ~ 148

Author(s):

Kai C. Wollert ◽

Tibor Kempf ◽

Bo Lagerqvist ◽

Bertil Lindahl ◽

Sylvia Olofsson ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Confidence Interval ◽

Risk Stratification ◽

Treatment Strategy ◽

Hazard Ratio ◽

Invasive Treatment ◽

Coronary Syndrome ◽

End Point ◽

St Elevation ◽

Elevation Acute Coronary Syndrome

Background— An invasive treatment strategy improves outcome in patients with non–ST-elevation acute coronary syndrome at moderate to high risk. We hypothesized that the circulating level of growth differentiation factor 15 (GDF-15) may improve risk stratification. Methods and Results— The Fast Revascularization during InStability in Coronary artery disease II (FRISC-II) trial randomized patients with non–ST-elevation acute coronary syndrome to an invasive or conservative strategy with a follow-up for 2 years. GDF-15 and other biomarkers were determined on admission in 2079 patients. GDF-15 was moderately elevated (between 1200 and 1800 ng/L) in 770 patients (37.0%), and highly elevated (>1800 ng/L) in 493 patients (23.7%). Elevated levels of GDF-15 independently predicted the risk of the composite end point of death or recurrent myocardial infarction in the conservative group ( P =0.016) but not in the invasive group. A significant interaction existed between the GDF-15 level on admission and the effect of treatment strategy on the composite end point. The occurrence of the composite end point was reduced by the invasive strategy at GDF-15 levels >1800 ng/L (hazard ratio, 0.49; 95% confidence interval, 0.33 to 0.73; P =0.001), between 1200 and 1800 ng/L (hazard ratio, 0.68; 95% confidence interval, 0.46 to 1.00; P =0.048), but not <1200 ng/L (hazard ratio, 1.06; 95% confidence interval, 0.68 to 1.65; P =0.81). Patients with ST-segment depression or a troponin T level >0.01 μg/L with a GDF-15 level <1200 ng/L did not benefit from the invasive strategy. Conclusions— GDF-15 is a potential tool for risk stratification and therapeutic decision making in patients with non–ST-elevation acute coronary syndrome as initially diagnosed by ECG and troponin levels. A prospective randomized trial is needed to validate these findings.

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Comparison of invasive treatment strategies in patients with non–ST elevation acute coronary syndrome: A systematic review and meta-analysis

JTCVS Open ◽

10.1016/j.xjon.2021.08.028 ◽

2021 ◽

Author(s):

Rikuta Hamaya ◽

Yuan Ting Chang ◽

Api Chewcharat ◽

Nicholas Chiu ◽

Taishi Yonetsu ◽

...

Keyword(s):

Systematic Review ◽

Acute Coronary Syndrome ◽

Meta Analysis ◽

Treatment Strategies ◽

Invasive Treatment ◽

Coronary Syndrome ◽

St Elevation ◽

Elevation Acute Coronary Syndrome

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The Bleeding Safety of Ticagrelor in Patients With ST-Elevation Acute Coronary Syndrome Treated With Fibrinolytic Therapy

Kardiologiia ◽

10.18087/cardio.2020.6.n867 ◽

2020 ◽

Vol 60 (6) ◽

pp. 92-95

Author(s):

A. V. Bocharov ◽

D. V. Sidorov

Keyword(s):

Acute Coronary Syndrome ◽

Treatment Group ◽

Fibrinolytic Therapy ◽

Intracranial Hemorrhages ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

St Elevation ◽

Elevation Acute Coronary Syndrome

Aim To compare hemorrhagic safety of ticagrelor and clopidogrel in patients with ST-segment elevation acute coronary syndrome (STEACS) after thrombolytic therapy (TLT).Material and methods This nonrandomized study included 183 patients followed up for 30 days. Hemorrhagic safety was compared in a group of patients with STEACS (n=71) after a thrombolytic treatment with alteplase and early ticagrelor treatment (180 mg followed by switching to 90 mg twice daily) and in a group of patients (n=112) with STEACS receiving TLT with alteplase and clopidogrel (loading dose, 600 mg followed by switching to 75 mg daily). Primary endpoint was hemorrhage associated with TLT; patients were followed up for 30 days.Results During the follow-up period, TLT-associated hemorrhages were observed in 11.3% of patients in the ticagrelor treatment group and in 10.7% of patients in the clopidogrel treatment group (p=0.9; odds ratio, 1.06 at 95 % confidence interval, from 0.41 to 2.73). Intracranial hemorrhages and fatal hemorrhages were absent in both groups.Conclusion There were no significant differences in hemorrhagic safety between patients with STEACS after the TLT treatment with alteplase and early treatment with ticagrelor or clopidogrel.

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