Abstract
Aims 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. Methods and 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 nonPCI 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.
Original language | English |
---|---|
Pages (from-to) | 181-187 |
Journal | Netherlands Heart Journal |
Volume | 24 |
Issue number | 3 |
DOIs | |
Publication status | Published - Mar 2016 |
Keywords
- Non ST-segment elevation acute coronary syndrome
- Revascularisation
- Timing
- Elderly
- Clinical outcome
- Interventional clinics
- Non-interventional clinics