[The effect of early invasive strategy on early and late outcomes in high-risk non-ST-segment elevation acute coronary syndromes].
OBJECTIVE
To investigate the effect of early invasive strategy on early and late outcomes in high-risk patients with non-ST-segment elevation acute coronary syndromes (ACS).


METHODS
Five hundred and forty-five patients of ACS without ST-segment elevation were randomly assigned to an early conservative strategy (284 cases) or early invasive strategy group (261 cases), who were enrolled consecutively from Oct., 2001 to Oct., 2003. The combined cardiovascular events (a combination of cardiac death, nonfatal myocardial infarction, nonfatal heart failure and hospital readmission due to recurrent ischemic angina) within 30 days and 6 months were analyzed and the effects of early invasive strategy on early and late outcomes in high-risk patients with increased TnI or hs-CRP levels were evaluated.


RESULTS
As compared with early conservative strategy, early invasive strategy lowered the rate of hospital readmission due to recurrent ischemic angina of 30 d and the combined cardiovascular events of 30 d and 6 months (all P < 0.05). Subgroup analysis indicated early invasive strategy could significantly decrease the incidences of the combined cardiovascular events of 30 d and 6 months and the hard end point events of 6 months in patients with increased TnI or hs-CRP levels (all P < 0.01), but no such changes could be seen in patients with normal TnI or hs-CRP levels, as compared with early conservative strategy.


CONCLUSIONS
Early invasive strategy decreases significantly cardiovascular events and improves the early and late outcomes in high-risk patients with increased TnI or hs-CRP levels.
Zhao
Ming-zhong
MZ
Department of Cardiology, People's Hospital, Peking University, Beijing 100044, China.
Hu
Da-yi
DY
Jiang
Li-qing
LQ
Wu
Yang
Y
Zhu
Tian-gang
TG
Hao
Heng-jian
HJ
Zhang
Li-jing
LJ
Huo
Yong
Y
Wang
Ming-sheng
MS
D000368:Aged; D000789:Angina, Unstable / Q000628:therapy*; D002097:C-Reactive Protein / Q000032:analysis; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D011379:Prognosis; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
D019210:Troponin I; D002097:C-Reactive Protein