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28-01-2016 | Original Article | Uitgave 3/2016 Open Access

Netherlands Heart Journal 3/2016

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

Tijdschrift:
Netherlands Heart Journal > Uitgave 3/2016
Auteurs:
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

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 non-PCI 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.

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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie en de Nederlandse Hartstichting. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

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