Comparison of immediate vs early invasive strategy in patients with first acute non-ST-elevation myocardial infarction.
BACKGROUND
The best timing for coronary angiography (immediate vs early) in patients with acute non-ST-elevation myocardial infarction (NSTEMI) is controversial.


OBJECTIVE
Evaluate in NSTEMI patients the effects of an immediate compared to an early invasive strategy on microvascular damage, myocardial perfusion, and infarct size.


METHODS
We randomized 54 consecutive patients with first episode of NSTEMI: 27 patients (22 males, age 58.8 ± 9.4 years, group A) underwent immediate (≤6 hours) percutaneous coronary intervention (PCI) with a double bolus of eptifibatide, and 27 patients (24 males, age 59.7 ± 9.8 years, P = 0.72, group B) underwent early (7-72 hours) PCI with upstream eptifibatide. Microvascular damage was evaluated at predischarge by myocardial contrast echocardiography, and the contrast defect length was calculated.


RESULTS
There were no significant differences in pre-PCI myocardial blush grade (MBG) (41% MBG 0 or 1 in group A vs 37% MBG 0 or 1 in group B, P = 0.78), in post-PCI MBG (7.4% MBG 0 or 1 in both groups, P = 1.00), and in contrast defect length (4.5% in group A vs 2.8% in group B, P = 0.56). However, group A showed a significant reduction in creatine kinase myocardial band isoenzyme peak (26 ± 26 ng/mL in group A vs 69 ± 79 ng/mL in group B, P = 0.01) and in troponin T peak (0.84 ± 1.2 ng/mL in group A vs 1.8 ± 2.1 ng/mL in group B, P = 0.048).


CONCLUSIONS
In patients with NSTEMI treated with eptifibatide, immediate PCI is associated with less increase in myonecrosis markers compared with PCI within 72 hours. There were no significant differences in myocardial perfusion between the 2 strategies.
Policlinico Casilino-ASL RMB, Rome, Italy.
Alessandro
A
Sciahbasi
Università La Sapienza, Rome, Italy.
Mariapina
M
Madonna
UO Cardiologia, Ospedale Morgagni-Pierantoni, Forlì, Italy.
Maria
M
De Vita
Università La Sapienza, Rome, Italy.
Luciano
L
Agati
Policlinico Casilino-ASL RMB, Rome, Italy.
Roberto
R
Scioli
Policlinico Casilino-ASL RMB, Rome, Italy.
Francesco
F
Summaria
Policlinico Casilino-ASL RMB, Rome, Italy.
Enrico
E
Romagnoli
Policlinico Casilino-ASL RMB, Rome, Italy.
Roberto
R
Patrizi
Policlinico Casilino-ASL RMB, Rome, Italy.
Chiara
C
Lanzillo
Università de L'Aquila, Italy.
Gianluca
G
Pendenza
Università La Sapienza, Rome, Italy.
Emanuele
E
Canali
Università de L'Aquila, Italy.
Maria
M
Penco
Policlinico Casilino-ASL RMB, Rome, Italy.
Ernesto
E
Lioy
D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D018450:Disease Progression; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
D005343:Fibrinolytic Agents