Early invasive treatment benefits long-lasting in non-ST-elevation ACS
medwireNews: Early invasive treatment postpones the occurrence of death or recurrent myocardial infarction (MI) by an average of 18 months compared with a noninvasive strategy in patients with non-ST-elevation acute coronary syndrome (ACS), show results of a 15-year follow-up of FRISC-II participants.
The effect was greater in nonsmokers and patients with elevated troponin T or growth differentiation factor (GDF)-15, and “was mainly driven by a significantly lower rate of new events during the first 3–4 years after randomisation to the early invasive versus the non-invasive strategy, with a similar risk of new events in the following years”, Lars Wallentin (Uppsala Clinical Research Center, Sweden) and fellow investigators report.
They also note that the postponement associated with invasive treatment was largely due to a delay in new MI rather than mortality, for which the difference observed in shorter-term studies was not sustained during the follow-up period.
In the current analysis, which included mortality data from 99% of the original 2457 FRISC-II patients and data for other events from 89%, the researchers investigated the long-term effects of each strategy on all cardiovascular events, including repeated nonfatal events.
During a minimum 15 years of follow-up, patients in the invasive group experienced 928 deaths or MIs compared with 1040 events in the noninvasive group.
The researchers found that the invasive strategy postponed death or next MI by a significant 549 days or 18 months, on average, compared with the noninvasive strategy.
They report in The Lancet that the effect was larger in nonsmokers, patients with elevated troponin T and patients with high concentrations of GDF-15, who had average delays to death or next MI of 27, 26 and 45 months, respectively.
The mean delay in deaths and readmissions for ischaemic heart disease was approximately 37 months with the invasive strategy compared with noninvasive management, and was consistent across all subgroups.
Wallentin et al note: “During the 15 years of follow-up, almost half the patients died, more than half had the primary outcome event of death or myocardial infarction, and about 80% were readmitted to hospital at least once for heart disease.
“Therefore, the present analyses provide a remaining lifetime perspective on the effects of early invasive versus non-invasive treatment in patients with non-ST-elevation acute coronary syndrome and a median age of 66 years at randomisation.”
The authors conclude: “These findings strongly support early invasive treatment as the preferred strategy in most patients with non-ST-elevation acute coronary syndrome, and suggest that prioritisation of procedures might be facilitated by use of biomarkers such as troponin-T and GDF-15.”
By Laura Cowen
medwireNews is an independent medical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2016