title: Impact of percutaneous coronary intervention timing on 5-year outcome in patients with non-ST-segment elevation acute coronary syndromes. The 'wait a day' approach might be safer.
abstract: BACKGROUND
  The OPTIMA trial was a randomised multicentre trial exploring the influence of the timing of percutaneous coronary intervention (PCI) on patient outcomes in an intermediate to high risk non-ST-elevation acute coronary syndrome (NSTE-ACS) population. In order to decide the best treatment strategy for patients presenting with NSTE-ACS, long-term outcomes are essential.
  
  
  METHODS
  Five-year follow-up data from 133 of the 142 patients could be retrieved (94 %). The primary endpoint was a composite of death and spontaneous myocardial infarction (MI). Spontaneous MI was defined as MI occurring more than 30 days after randomisation. Secondary endpoints were the individual outcomes of death, spontaneous MI or re-PCI.
  
  
  RESULTS
  No significant difference with respect to the primary endpoint was observed (17.8 vs. 10.1 %; HR 1.55, 95 % CI: 0.73-4.22, p = 0.21). There was no significant difference in mortality rate. However, spontaneous MI was significantly more common in the group receiving immediate PCI (11.0 vs. 1.4 %; HR 4.46, 95 % CI: 1.21-16.50, p = 0.02). We did not find a significant difference between the groups with respect to re-PCI rate.
  
  
  CONCLUSIONS
  There was no difference in the composite of death and spontaneous MI. The trial suggests an increased long-term risk of spontaneous MI for patients treated with immediate PCI.
authors: Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1090 HM, PO Box 95500, Amsterdam, The Netherlands. erikoosterwerff@hotmail.com.
authors: Erik F J
authors: EF
authors: Oosterwerff
authors: Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1090 HM, PO Box 95500, Amsterdam, The Netherlands.
authors: N D
authors: ND
authors: Fagel
authors: Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1090 HM, PO Box 95500, Amsterdam, The Netherlands.
authors: T
authors: T
authors: Slagboom
authors: Heart Centre, Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.
authors: J G P
authors: JG
authors: Tijssen
authors: Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1090 HM, PO Box 95500, Amsterdam, The Netherlands.
authors: J P
authors: JP
authors: Herrman
authors: Heart Centre, Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands.
authors: P C
authors: PC
authors: Smits
authors: Heart Centre, Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands.
authors: M J
authors: MJ
authors: Suttorp
authors: Heart Centre, Department of Cardiology, Reinier de Graaf Hospital, Delft, The Netherlands.
authors: E
authors: E
authors: Ronner
authors: Heart Centre, Department of Cardiology, TweeSteden Hospital, Tilburg, The Netherlands.
authors: G J
authors: GJ
authors: Laarman
authors: Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1090 HM, PO Box 95500, Amsterdam, The Netherlands.
authors: M S
authors: MS
authors: Patterson
authors: Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1090 HM, PO Box 95500, Amsterdam, The Netherlands.
authors: G
authors: G
authors: Amoroso
authors: Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1090 HM, PO Box 95500, Amsterdam, The Netherlands.
authors: M A
authors: MA
authors: Vink
authors: Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1090 HM, PO Box 95500, Amsterdam, The Netherlands.
authors: R J
authors: RJ
authors: van der Schaaf
authors: Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1090 HM, PO Box 95500, Amsterdam, The Netherlands.
authors: F W A
authors: FW
authors: Verheugt
authors: Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1090 HM, PO Box 95500, Amsterdam, The Netherlands.
authors: R K
authors: RK
authors: Riezebos
keywords: Long-term outcomes; NSTE-ACS; Timing of PCI