title: Timing of intervention in high-risk non-ST-elevation acute coronary syndromes in PCI versus non-PCI centres : Sub-group analysis of the ELISA-3 trial.
abstract: OBJECTIVE
  To compare the effect of timing of intervention in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) in percutaneous coronary intervention (PCI) versus non-PCI centres.
  
  
  RESULTS
  A post-hoc sub-analysis was performed of the ELISA III trial, a randomised multicentre trial investigating outcome of early (< 12 h) versus late (> 48 h) angiography and revascularisation in 542 patients with high-risk NSTE-ACS. 90 patients were randomised in non-PCI centres and tended to benefit more from an early invasive strategy than patients included in the PCI centre (relative risk 0.23 vs. 0.85 [p for interaction = 0.089] for incidence of the combined primary endpoint of death, reinfarction and recurrent ischaemia after 30 days of follow-up). This was largely driven by reduction in recurrent ischaemia. In non-PCI centres, patients randomised to the late group had a 4 and 7 day longer period until PCI or coronary artery bypass grafting, respectively. This difference was less pronounced in the PCI centre.
  
  
  CONCLUSIONS
  This post-hoc analysis from the ELISA-3 trial suggests that NSTE-ACS patients initially hospitalised in non-PCI centres show the largest benefit from early angiography and revascularisation, associated with a shorter waiting time to revascularisation. Improved patient logistics and transfer between non-PCI and PCI centres might therefore result in better clinical outcome.
authors.affiliation: Deventer Hospital, Deventer, The Netherlands.
authors.forename: E A
authors.initials: EA
authors.lastname: Badings
authors.affiliation: Isala Klinieken, Dokter van Heesweg 2, 8025AB, Zwolle, The Netherlands.
authors.forename: W S
authors.initials: WS
authors.lastname: Remkes
authors.affiliation: Isala Klinieken, Dokter van Heesweg 2, 8025AB, Zwolle, The Netherlands.
authors.forename: J-H E
authors.initials: JH
authors.lastname: Dambrink
authors.affiliation: Treant Zorggroep location Bethesda, Hoogeveen, The Netherlands.
authors.forename: S H K
authors.initials: SH
authors.lastname: The
authors.affiliation: Deventer Hospital, Deventer, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Van Wijngaarden
authors.affiliation: Hospital De Tjongerschans, Heerenveen, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Tjeerdsma
authors.affiliation: Atrium Medisch Centrum, Heerlen, The Netherlands.|Maastricht UMC, Maastricht, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Rasoul
authors.affiliation: Isala Klinieken, Dokter van Heesweg 2, 8025AB, Zwolle, The Netherlands.
authors.forename: J R
authors.initials: JR
authors.lastname: Timmer
authors.affiliation: Treant Zorggroep location Bethesda, Hoogeveen, The Netherlands.
authors.forename: M L J
authors.initials: ML
authors.lastname: van der Wielen
authors.affiliation: Deventer Hospital, Deventer, The Netherlands.
authors.forename: D J A
authors.initials: DJ
authors.lastname: Lok
authors.affiliation: Isala Klinieken, Dokter van Heesweg 2, 8025AB, Zwolle, The Netherlands. a.w.j.vant.hof@isala.nl.
authors.forename: A W J
authors.initials: AW
authors.lastname: van 't Hof
keywords: Clinical outcome; Elderly; Interventional clinics; Non ST-segment elevation acute coronary syndrome; Non-interventional clinics; Revascularisation; Timing
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