Comparison of Acute Versus Subacute Coronary Angiography in Patients With NON-ST-Elevation Myocardial Infarction (from the NONSTEMI Trial)

Martin B Rasmussen; Carsten Stengaard; Jacob T Sørensen; Ingunn S Riddervold; Hanne M Søndergaard; Troels Niemann; Karen Kaae Dodt; Lars Frost; Tage Jensen; Bent Raungaard; Troels M Hansen; Matthias Giebner; Claus-Henrik Rasmussen; Hans Erik Bøtker; Steen D Kristensen; Michael Maeng; Evald H Christiansen; Christian J Terkelsen

doi:10.1016/j.amjcard.2019.06.007

Comparison of Acute Versus Subacute Coronary Angiography in Patients With NON-ST-Elevation Myocardial Infarction (from the NONSTEMI Trial)

Martin B Rasmussen, Carsten Stengaard, Jacob T Sørensen, Ingunn S Riddervold, Hanne M Søndergaard, Troels Niemann, Karen Kaae Dodt, Lars Frost, Tage Jensen, Bent Raungaard, Troels M Hansen, Matthias Giebner, Claus-Henrik Rasmussen, Hans Erik Bøtker, Steen D Kristensen, Michael Maeng, Evald H Christiansen, Christian J Terkelsen

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

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Abstract

The optimal timing of coronary angiography (CAG) in high-risk patients with acute coronary syndrome without persisting ST-segment elevation (NST-ACS) remains undetermined. The NON-ST-Elevation Myocardial Infarction trial aimed to compare outcomes in NSTE-ACS patients randomized to acute CAG (STEMI-like approach) with patients randomized to medical therapy and subacute CAG. We randomized 496 patients with suspected NST-ACS based on symptoms and significant regional ST depressions and/or elevated point-of-care troponin T (POC-cTnT) (≥50 ng/l) to either acute CAG (<2 hours, n = 245) or subacute CAG (<72 hours, n = 251). The primary end point was a composite of all-cause death, reinfarction, and readmission with congestive heart failure within 1 year from randomization. A final acute coronary syndrome (ACS) diagnosis was assigned to 429 (86.5%) patients. The median time from randomization to revascularization was 1.3 hours in the acute CAG group versus 51.1 hours in the subacute CAG group (p <0.001). The composite end point occurred in 25 patients (10.2%) in the acute CAG group and 29 (11.6%) in the subacute CAG group, p = 0.62. The acute CAG group had a 1-year all-cause mortality of 5.7% compared with 5.6% in the subacute CAG group, p = 0.96. In conclusion, neither the composite end point of all-cause death, reinfarction, and readmission with congestive heart failure nor mortality differed between an acute and subacute CAG approach in NSTE-ACS patients. However, identification of NSTE-ACS patients in the prehospital phase and direct triage to an invasive center is feasible, safe and may facilitate early diagnosis and revascularization.

Original language	English
Journal	The American Journal of Cardiology
Volume	124
Issue	6
Pages (from-to)	825-832
Number of pages	8
ISSN	0002-9149
DOIs	https://doi.org/10.1016/j.amjcard.2019.06.007
Publication status	Published - Sept 2019

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Rasmussen, M. B., Stengaard, C., Sørensen, J. T., Riddervold, I. S., Søndergaard, H. M., Niemann, T., Dodt, K. K., Frost, L., Jensen, T., Raungaard, B., Hansen, T. M., Giebner, M., Rasmussen, C.-H., Bøtker, H. E., Kristensen, S. D., Maeng, M., Christiansen, E. H., & Terkelsen, C. J. (2019). Comparison of Acute Versus Subacute Coronary Angiography in Patients With NON-ST-Elevation Myocardial Infarction (from the NONSTEMI Trial). The American Journal of Cardiology, 124(6), 825-832. https://doi.org/10.1016/j.amjcard.2019.06.007

@article{055eecaa787b4eb399b48efa81ceddbc,

title = "Comparison of Acute Versus Subacute Coronary Angiography in Patients With NON-ST-Elevation Myocardial Infarction (from the NONSTEMI Trial)",

abstract = "The optimal timing of coronary angiography (CAG) in high-risk patients with acute coronary syndrome without persisting ST-segment elevation (NST-ACS) remains undetermined. The NON-ST-Elevation Myocardial Infarction trial aimed to compare outcomes in NSTE-ACS patients randomized to acute CAG (STEMI-like approach) with patients randomized to medical therapy and subacute CAG. We randomized 496 patients with suspected NST-ACS based on symptoms and significant regional ST depressions and/or elevated point-of-care troponin T (POC-cTnT) (≥50 ng/l) to either acute CAG (<2 hours, n = 245) or subacute CAG (<72 hours, n = 251). The primary end point was a composite of all-cause death, reinfarction, and readmission with congestive heart failure within 1 year from randomization. A final acute coronary syndrome (ACS) diagnosis was assigned to 429 (86.5%) patients. The median time from randomization to revascularization was 1.3 hours in the acute CAG group versus 51.1 hours in the subacute CAG group (p <0.001). The composite end point occurred in 25 patients (10.2%) in the acute CAG group and 29 (11.6%) in the subacute CAG group, p = 0.62. The acute CAG group had a 1-year all-cause mortality of 5.7% compared with 5.6% in the subacute CAG group, p = 0.96. In conclusion, neither the composite end point of all-cause death, reinfarction, and readmission with congestive heart failure nor mortality differed between an acute and subacute CAG approach in NSTE-ACS patients. However, identification of NSTE-ACS patients in the prehospital phase and direct triage to an invasive center is feasible, safe and may facilitate early diagnosis and revascularization.",

author = "Rasmussen, {Martin B} and Carsten Stengaard and S{\o}rensen, {Jacob T} and Riddervold, {Ingunn S} and S{\o}ndergaard, {Hanne M} and Troels Niemann and Dodt, {Karen Kaae} and Lars Frost and Tage Jensen and Bent Raungaard and Hansen, {Troels M} and Matthias Giebner and Claus-Henrik Rasmussen and B{\o}tker, {Hans Erik} and Kristensen, {Steen D} and Michael Maeng and Christiansen, {Evald H} and Terkelsen, {Christian J}",

year = "2019",

month = sep,

doi = "10.1016/j.amjcard.2019.06.007",

language = "English",

volume = "124",

pages = "825--832",

journal = "The American Journal of Cardiology",

issn = "0002-9149",

publisher = "Elsevier Inc.",

number = "6",

}

Rasmussen, MB, Stengaard, C, Sørensen, JT, Riddervold, IS, Søndergaard, HM, Niemann, T, Dodt, KK, Frost, L, Jensen, T, Raungaard, B, Hansen, TM, Giebner, M, Rasmussen, C-H, Bøtker, HE , Kristensen, SD , Maeng, M , Christiansen, EH & Terkelsen, CJ 2019, 'Comparison of Acute Versus Subacute Coronary Angiography in Patients With NON-ST-Elevation Myocardial Infarction (from the NONSTEMI Trial)', The American Journal of Cardiology, vol. 124, no. 6, pp. 825-832. https://doi.org/10.1016/j.amjcard.2019.06.007

Comparison of Acute Versus Subacute Coronary Angiography in Patients With NON-ST-Elevation Myocardial Infarction (from the NONSTEMI Trial). / Rasmussen, Martin B; Stengaard, Carsten; Sørensen, Jacob T et al.
In: The American Journal of Cardiology, Vol. 124, No. 6, 09.2019, p. 825-832.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Comparison of Acute Versus Subacute Coronary Angiography in Patients With NON-ST-Elevation Myocardial Infarction (from the NONSTEMI Trial)

AU - Rasmussen, Martin B

AU - Stengaard, Carsten

AU - Sørensen, Jacob T

AU - Riddervold, Ingunn S

AU - Søndergaard, Hanne M

AU - Niemann, Troels

AU - Dodt, Karen Kaae

AU - Frost, Lars

AU - Jensen, Tage

AU - Raungaard, Bent

AU - Hansen, Troels M

AU - Giebner, Matthias

AU - Rasmussen, Claus-Henrik

AU - Bøtker, Hans Erik

AU - Kristensen, Steen D

AU - Maeng, Michael

AU - Christiansen, Evald H

AU - Terkelsen, Christian J

PY - 2019/9

Y1 - 2019/9

N2 - The optimal timing of coronary angiography (CAG) in high-risk patients with acute coronary syndrome without persisting ST-segment elevation (NST-ACS) remains undetermined. The NON-ST-Elevation Myocardial Infarction trial aimed to compare outcomes in NSTE-ACS patients randomized to acute CAG (STEMI-like approach) with patients randomized to medical therapy and subacute CAG. We randomized 496 patients with suspected NST-ACS based on symptoms and significant regional ST depressions and/or elevated point-of-care troponin T (POC-cTnT) (≥50 ng/l) to either acute CAG (<2 hours, n = 245) or subacute CAG (<72 hours, n = 251). The primary end point was a composite of all-cause death, reinfarction, and readmission with congestive heart failure within 1 year from randomization. A final acute coronary syndrome (ACS) diagnosis was assigned to 429 (86.5%) patients. The median time from randomization to revascularization was 1.3 hours in the acute CAG group versus 51.1 hours in the subacute CAG group (p <0.001). The composite end point occurred in 25 patients (10.2%) in the acute CAG group and 29 (11.6%) in the subacute CAG group, p = 0.62. The acute CAG group had a 1-year all-cause mortality of 5.7% compared with 5.6% in the subacute CAG group, p = 0.96. In conclusion, neither the composite end point of all-cause death, reinfarction, and readmission with congestive heart failure nor mortality differed between an acute and subacute CAG approach in NSTE-ACS patients. However, identification of NSTE-ACS patients in the prehospital phase and direct triage to an invasive center is feasible, safe and may facilitate early diagnosis and revascularization.

AB - The optimal timing of coronary angiography (CAG) in high-risk patients with acute coronary syndrome without persisting ST-segment elevation (NST-ACS) remains undetermined. The NON-ST-Elevation Myocardial Infarction trial aimed to compare outcomes in NSTE-ACS patients randomized to acute CAG (STEMI-like approach) with patients randomized to medical therapy and subacute CAG. We randomized 496 patients with suspected NST-ACS based on symptoms and significant regional ST depressions and/or elevated point-of-care troponin T (POC-cTnT) (≥50 ng/l) to either acute CAG (<2 hours, n = 245) or subacute CAG (<72 hours, n = 251). The primary end point was a composite of all-cause death, reinfarction, and readmission with congestive heart failure within 1 year from randomization. A final acute coronary syndrome (ACS) diagnosis was assigned to 429 (86.5%) patients. The median time from randomization to revascularization was 1.3 hours in the acute CAG group versus 51.1 hours in the subacute CAG group (p <0.001). The composite end point occurred in 25 patients (10.2%) in the acute CAG group and 29 (11.6%) in the subacute CAG group, p = 0.62. The acute CAG group had a 1-year all-cause mortality of 5.7% compared with 5.6% in the subacute CAG group, p = 0.96. In conclusion, neither the composite end point of all-cause death, reinfarction, and readmission with congestive heart failure nor mortality differed between an acute and subacute CAG approach in NSTE-ACS patients. However, identification of NSTE-ACS patients in the prehospital phase and direct triage to an invasive center is feasible, safe and may facilitate early diagnosis and revascularization.

U2 - 10.1016/j.amjcard.2019.06.007

DO - 10.1016/j.amjcard.2019.06.007

M3 - Journal article

C2 - 31324357

SN - 0002-9149

VL - 124

SP - 825

EP - 832

JO - The American Journal of Cardiology

JF - The American Journal of Cardiology

IS - 6

ER -

Comparison of Acute Versus Subacute Coronary Angiography in Patients With NON-ST-Elevation Myocardial Infarction (from the NONSTEMI Trial)

Abstract

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