title: Optimal timing of invasive angiography in stable non-ST-elevation myocardial infarction: the Leipzig Immediate versus early and late PercutaneouS coronary Intervention triAl in NSTEMI (LIPSIA-NSTEMI Trial).
abstract: OBJECTIVE
  The optimal timing of intervention in non-ST-elevation myocardial infarction (NSTEMI) remains uncertain. The aim of this multicentre trial was to assess whether an immediate invasive approach is superior to an early invasive or a selective invasive approach with respect to reduction of large infarction.
  
  
  RESULTS
  Patients with NSTEMI were randomized to either an immediate (<2 h after randomization; n= 201), an early (10-48 h after randomization; n= 200), or a selective invasive approach with high invasive percentage (n= 201). The primary outcome was the peak creatine kinase (CK)-myocardial band (MB) activity during index hospitalization; key secondary clinical endpoints were the composite of (i) death and non-fatal infarction; (ii) death, non-fatal infarction, and refractory ischaemia; (iii) death, non-fatal infarction, refractory ischaemia, and rehospitalization for unstable angina within 6 months. The median time from randomization to angiography was 1.1 h in the immediate vs. 18.6 h in the early and 67.2 h in the selective invasive group (P< 0.001). There was no significant difference in the peak CK-MB activity between groups. The key secondary clinical endpoints were similar between groups at 6-month follow-up: death and infarction: 21.0 vs. 16.0 vs. 14.5%; P= 0.17; death, infarction, refractory ischaemia: 20.9 vs. 21.5 vs. 22.0%; P= 0.98; death, infarction, refractory ischaemia, rehospitalization: 26.0 vs. 26.5 vs. 24.5%; P= 0.91, respectively.
  
  
  CONCLUSIONS
  In NSTEMI patients, an immediate invasive approach does not offer an advantage over an early or a selective invasive approach with respect to large myocardial infarctions as defined by peak CK-MB levels, which is supported by similar clinical outcomes. ClinicalTrials.gov NCT00402675.
authors: Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany. thielh@medizin.uni-leipzig.de
authors: Holger
authors: H
authors: Thiele
authors: Justus
authors: J
authors: Rach
authors: Norbert
authors: N
authors: Klein
authors: Dietrich
authors: D
authors: Pfeiffer
authors: Andreas
authors: A
authors: Hartmann
authors: Rainer
authors: R
authors: Hambrecht
authors: Peter
authors: P
authors: Sick
authors: Ingo
authors: I
authors: Eitel
authors: Steffen
authors: S
authors: Desch
authors: Gerhard
authors: G
authors: Schuler
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality; D011859:Radiography; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers