title: [Early invasive strategy no better than a selective invasive strategy for patients with non-ST-segment elevation acute coronary syndromes and elevated cardiac troponin T levels: long-term follow-up results of the ICTUS trial].
abstract: OBJECTIVE
  To determine whether routine coronary angiography followed by revascularisation where appropriate is better than initial drug treatment in patients with non-ST-segment elevation acute coronary syndromes (nSTE-ACS) and elevated troponin T concentrations.
  
  
  METHODS
  Multicentre randomised clinical trial (www.controlled-trials. com, number: SRCTN82153174).
  
  
  METHODS
  Patients with nSTE-ACS and elevated cardiac troponin were randomly assigned to an early invasive strategy or a selective invasive strategy. The early invasive strategy consisted of coronary angiography and revascularisation as indicated within 48 hours. The selective invasive strategy consisted of initial drug therapy; catheterisation was performed if the patient developed refractory angina or recurrent ischaemia. The main endpoints were a composite of death, recurrent myocardial infarction and rehospitalisation for anginal symptoms within 3 years, and all-cause mortality within 4 years.
  
  
  RESULTS
  A total of 1200 patients were enrolled from 42 hospitals in the Netherlands. The in-hospital revascularisation rate was 76% in the early invasive group and 40% in the selective invasive group. After 3 years, the cumulative rate for the composite endpoint was 30.0% in the early invasive group and 26.0% in the selective invasive group (hazard ratio 1.21; 95% CI: 0.97-1.50; p = 0.09). The 4-year all-cause mortality rate was similar in both treatment groups (7.9% vs 7.7%; p = 0.62).
  
  
  CONCLUSIONS
  Long-term follow-up of this trial suggests that an early invasive strategy is not better than a selective invasive strategy in patients with nSTE-ACS and elevated cardiac troponin. Therefore, implementation of either strategy is acceptable in these patients.
authors: Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Cardiologie, B2-137, Meibergdreef 9, 1105 AZ Amsterdam.
authors: F
authors: F
authors: Windhausen
authors: A
authors: A
authors: Hirsch
authors: J G P
authors: JG
authors: Tijssen
authors: F W A
authors: FW
authors: Verheugt
authors: J H
authors: JH
authors: Cornel
authors: R J
authors: RJ
authors: de Winter