Treatment of refractory unstable angina in geographically isolated areas without cardiac surgery. Invasive versus conservative strategy (TRUCS study).
OBJECTIVE
We compared invasive (on-site coronary angioplasty or emergency air-ambulance transfer for bypass grafting surgery) vs conservative (persistent medical treatment) strategies in the management of refractory unstable angina in geographically isolated hospitals without cardiac surgical facilities.


RESULTS
One hundred and forty eight randomized patients with refractory unstable angina were compared on an intention-to-treat basis. Outcomes (invasive vs conservative): (a) in hospital: stabilization (96% vs 43%, P=0.0001), non-fatal myocardial infarction (2.6% vs 4.2%, P=ns), death (1.3% vs 8.3%, P=0.046), combined outcome (3.9% vs 12.5%, P=0.053) and hospitalization (11.4+/-6.3 vs 12.4+/-8.0 days, P=ns). (b) 30-days follow-up: non-fatal myocardial infarction (2.6% vs 4.2%, P=ns), death (2.6% vs 11.1%, P=0.030) and combined outcome (5.3% vs 15.3%, P=0.031). (c) 12 month follow-up: non-fatal myocardial infarction (3. 9% vs 4.2%, P=ns), death (3.9% vs 12.5%, P=0.053), combined outcome (7.9% vs 16.7%, P=ns), re-admissions for unstable angina: (17.1% vs 23.6%, P=ns), late coronary angioplasty: (15.8% vs 11.1%, P=ns) and (d) late coronary bypass grafting: (7.9% vs 12.5%, P=ns).


CONCLUSIONS
Invasive treatment of patients with refractory angina in remote areas without surgical back-up results in significant in-hospital stabilization and a reduction in major events in-hospital and at 30 days. Coronary angioplasty in stand-alone units and air-transfer of these patients seems safe.
Michalis
L K
LK
School of Medicine, Department of Internal Medicine, Division of Cardiology, University Campus, University of Ioannina, Ioannina, Greece.
Stroumbis
C S
CS
Pappas
K
K
Sourla
E
E
Niokou
D
D
Goudevenos
J A
JA
Siogas
C
C
Sideris
D A
DA
D017732:Air Ambulances; D000789:Angina, Unstable / Q000188:drug therapy* / Q000601:surgery*; D017130:Angioplasty; D001026:Coronary Artery Bypass; D005260:Female; D006115:Greece; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D015425:Myocardial Reperfusion; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors