title: Early or late intervention in patients with transient ST-segment elevation acute coronary syndrome: Subgroup analysis of the ELISA-3 trial.
abstract: OBJECTIVE
  To investigate incidence and patient characteristics of transient ST-segment elevation (TSTE) ACS and to compare outcome of early versus late invasive treatment.
  
  
  BACKGROUND
  Optimal timing of treatment in TSTE-ACS patients is not outlined in current guidelines and no prospective randomized trials have been done so far.
  
  
  METHODS
  Post hoc subgroup analysis of patients with TSTE randomized in the ELISA 3 trial. This study compared early (<12 h) versus late (>48 h) angiography and revascularization in 542 patients with high-risk NSTE-ACS. Primary endpoint was incidence of death, reinfarction, or recurrent ischemia at 30 days follow-up.
  
  
  RESULTS
  TSTE was present in 129 patients (24.2%) and associated with male gender, smoking and younger age. The primary endpoint occurred in 8.9% of patients with and 13.0% of patients without TSTE (RR = 0.681, P = 0.214). Incidence of death or MI after 2 year follow-up was 5.7 and 14.6% respectively (RR = 0.384, P = 0.008). Within the group of patients with TSTE, incidence of the primary endpoint was 5.8% in the early and 12.7% in the late treatment group (RR = 0.455, P = 0.213), driven by reduction in recurrent ischemia. Enzymatic infarct size, bleeding and incidence of death or recurrent MI at 2 years follow-up was comparable between the treatment groups.
  
  
  CONCLUSIONS
  In high-risk patients with NSTE-ACS, TSTE is frequently seen. Similar to findings in patients with high-risk NSTE-ACS, immediate angiography and revascularization in these patients is feasible but not superior to later treatment. Prospective randomized trials are needed to provide more evidence in the optimal timing of treatment in patients with TSTE-ACS. © 2016 Wiley Periodicals, Inc.
authors: Deventer Ziekenhuis, Deventer, Netherlands.
authors: Erik A
authors: EA
authors: Badings
authors: Isala Klinieken, Zwolle, Netherlands.
authors: Wouter S
authors: WS
authors: Remkes
authors: Treant Zorggroep, Locatie Ziekenhuis Bethesda, Hoogeveen, Netherlands.
authors: Salem H K
authors: SH
authors: The
authors: Isala Klinieken, Zwolle, Netherlands.
authors: Jan-Henk E
authors: JE
authors: Dambrink
authors: Ziekenhuis De Tjongerschans, Heerenveen, Netherlands.
authors: Geert
authors: G
authors: Tjeerdsma
authors: Atrium Medisch Centrum, Heerlen, Netherlands.|Maastricht UMC, Netherlands.
authors: Saman
authors: S
authors: Rasoul
authors: Isala Klinieken, Zwolle, Netherlands.
authors: Jorik R
authors: JR
authors: Timmer
authors: Treant Zorggroep, Locatie Ziekenhuis Bethesda, Hoogeveen, Netherlands.
authors: Marloes L J
authors: ML
authors: van der Wielen
authors: Deventer Ziekenhuis, Deventer, Netherlands.
authors: Dirk J A
authors: DJ
authors: Lok
authors: Isala Klinieken, Zwolle, Netherlands.
authors: Rik
authors: R
authors: Hermanides
authors: Deventer Ziekenhuis, Deventer, Netherlands.
authors: Jan
authors: J
authors: van Wijngaarden
authors: Isala Klinieken, Zwolle, Netherlands.|Radboudumc, Nijmegen, Netherlands.
authors: Harry
authors: H
authors: Suryapranata
authors: Isala Klinieken, Zwolle, Netherlands.
authors: Arnoud W J
authors: AW
authors: van 't Hof
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D000368:Aged; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: NSTE-ACS; PCI; timing; transient ST-elevation