title: Timing of angiography with a routine invasive strategy and long-term outcomes in non-ST-segment elevation acute coronary syndrome: a collaborative analysis of individual patient data from the FRISC II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) Trials.
abstract: OBJECTIVE
  This study sought to investigate long-term outcomes after early or delayed angiography in patients with non-ST-segment elevation acute coronary syndrome (nSTE-ACS) undergoing a routine invasive management.
  
  
  BACKGROUND
  The optimal timing of angiography in patients with nSTE-ACS is currently a topic for debate.
  
  
  METHODS
  Long-term follow-up after early (within 2 days) angiography versus delayed (within 3 to 5 days) angiography was investigated in the FRISC-II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) (FIR) nSTE-ACS patient-pooled database. The main outcome was cardiovascular death or myocardial infarction up to 5-year follow-up. Hazard ratios (HR) were calculated with Cox regression models. Adjustments were made for the FIR risk score, study, and the propensity of receiving early angiography using inverse probability weighting.
  
  
  RESULTS
  Of 2,721 patients originally randomized to the routine invasive arm, consisting of routine angiography and subsequent revascularization if suitable, 975 underwent early angiography and 1,141 delayed angiography. No difference was observed in 5-year cardiovascular death or myocardial infarction in unadjusted (HR: 1.06, 95% confidence interval [CI]: 0.79 to 1.42, p=0.61) and adjusted (HR: 0.93, 95% CI: 0.75 to 1.16, p=0.54) Cox regression models.
  
  
  CONCLUSIONS
  In the FIR database of patients presenting with nSTE-ACS, the timing of angiography was not related to long-term cardiovascular mortality or myocardial infarction. (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes [ICTUS]; ISRCTN82153174. Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction [the Third Randomised Intervention Treatment of Angina Trials (RITA-3)]; ISRCTN07752711).
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Damman
authors.forename: Nan
authors.initials: N
authors.lastname: van Geloven
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.forename: Bo
authors.initials: B
authors.lastname: Lagerqvist
authors.forename: Keith A A
authors.initials: KA
authors.lastname: Fox
authors.forename: Tim
authors.initials: T
authors.lastname: Clayton
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Pocock
authors.forename: Alexander
authors.initials: A
authors.lastname: Hirsch
authors.forename: Fons
authors.initials: F
authors.lastname: Windhausen
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000628:therapy; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis* / Q000628:therapy; D016001:Confidence Intervals; D003299:Cooperative Behavior; D017023:Coronary Angiography / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013223:Statistics as Topic; D013997:Time Factors; D016896:Treatment Outcome