Author + information
- Received August 31, 2015
- Revision received October 22, 2015
- Accepted November 5, 2015
- Published online March 28, 2016.
- Aleksandra Milosevic, MDa,b,
- Zorana Vasiljevic-Pokrajcic, MD, PhDc,
- Dejan Milasinovic, MDa,
- Jelena Marinkovic, PhDb,d,
- Vladan Vukcevic, MD, PhDa,c,
- Branislav Stefanovic, MD, PhDa,b,c,
- Milika Asanin, MD, PhDa,b,c,
- Miodrag Dikic, MDa,
- Sanja Stankovic, PhDe and
- Goran Stankovic, MD, PhDa,c,∗ ()
- aDepartment of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
- bEmergency Department, Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
- cFaculty of Medicine, University of Belgrade, Belgrade, Serbia
- dInstitute for Medical Statistics and Informatics, Belgrade, Serbia
- eCenter for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
- ↵∗Reprint requests and correspondence:
Dr. Goran Stankovic, Department of Cardiology, Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia.
Objectives This study aimed to assess the clinical impact of immediate versus delayed invasive intervention in patients with non–ST-segment myocardial infarction (NSTEMI).
Background Previous studies found conflicting results on the effects of earlier invasive intervention in a heterogeneous population of acute coronary syndromes without ST-segment elevation.
Methods We randomized 323 NSTEMI patients to an immediate-intervention group (<2 h after randomization, n = 162) and a delayed-intervention group (2 to 72 h, n = 161).The primary endpoint was the occurrence of death or new myocardial infarction (MI) at 30-day follow-up.
Results Median time from randomization to angiography was 1.4 h and 61.0 h in the immediate-intervention group and the delayed-intervention group, respectively (p < 0.001). At 30 days, the primary endpoint was achieved less frequently in patients undergoing immediate intervention (4.3% vs. 13%, hazard ratio: 0.32, 95% confidence interval: 0.13 to 0.74; p = 0.008). At 1 year, this difference persisted (6.8% in the immediate-intervention group vs. 18.8% in delayed-intervention group; hazard ratio: 0.34, 95% confidence interval: 0.17 to 0.67; p = 0.002). The observed results were mainly attributable to the occurrence of new MI in the pre-catheterization period (0 deaths + 0 MIs in the immediate-intervention group vs. 1 death + 10 MIs in the delayed-intervention group). The rate of deaths, new MI, or recurrent ischemia was lower in the immediate-intervention group at both 30 days (6.8% vs. 26.7%; p < 0.001) and 1 year (15.4% vs. 33.1%; p < 0.001).
Conclusions Immediate invasive strategy in NSTEMI patients is associated with lower rates of death or new MI compared with the delayed invasive strategy at early and midterm follow-up, mainly due to a decrease in the risk of new MI in the pre-catheterization period. (Immediate Versus Delayed Invasive Intervention for Non-STEMI Patients [RIDDLE-NSTEMI]; NCT02419833)
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 31, 2015.
- Revision received October 22, 2015.
- Accepted November 5, 2015.
- American College of Cardiology Foundation