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

E. A. Badings, W. S. Remkes, J-H. E. Dambrink, S. H. K. The, J. Van Wijngaarden, G. Tjeerdsma, S. Rasoul, J. R. Timmer, M. L. J. van der Wielen, D. J. A. Lok, A. W. J. van 't Hof*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Web of Science)

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 languageEnglish
Pages (from-to)181-187
JournalNetherlands Heart Journal
Volume24
Issue number3
DOIs
Publication statusPublished - Mar 2016

Keywords

  • Non ST-segment elevation acute coronary syndrome
  • Revascularisation
  • Timing
  • Elderly
  • Clinical outcome
  • Interventional clinics
  • Non-interventional clinics

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