Very early invasive coronary angiography (ICA) did not significantly improve overall long-term clinical outcomes in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) compared with an invasive strategy conducted within two to three days, based on findings from the VERDICT trial presented Aug. 28 at ESC Congress 2018 and published in Circulation. However, researchers did note that a very early strategy did improve long-term outcomes in those patients at highest risk.

A total of 2,147 patients from Denmark were randomized to either very early invasive evaluation (ICA within 12 hours) or standard invasive care (ICA within 48-72 hours). Among patients with significant coronary artery disease identified by ICA, coronary revascularization was performed in 88.4 percent of those in the very-early group and 83.1 percent assigned to standard care. Over a median follow-up time of 4.3 years, the primary endpoint of all-cause death, non-fatal recurrent myocardial infarction and hospitalization for heart failure or refractory myocardial ischemia, occurred in 27.5 percent of participants in the very early group and 29.5 percent in the standard care group. Among highest-rick patients the very early strategy did significantly improve outcomes compared with standard care (HR 0.81, 95 percent confidence interval [CI] 0.67–1.00, p-value for interaction = 0.023).

"Very early diagnosis and treatment was not superior to the deferred strategy," said Professor Thomas Engstrøm from Copenhagen University Hospital, Denmark. "The results suggest that postponing invasive examination and treatment for up to 72 hours is as good as a very early approach in patients with NSTE-ACS."

Clinical Topics: Anticoagulation Management, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Acute Heart Failure, Interventions and Imaging, Computed Tomography, Nuclear Imaging

Keywords: ESC18, ESC Congress, Aspirin, Adrenergic beta-Antagonists, Heart Failure, Hemorrhage, Heparin, Myocardial Infarction, Percutaneous Coronary Intervention, Purinergic P2Y Receptor Antagonists, Risk Assessment, Secondary Prevention, Tomography, Tomography, X-Ray Computed

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