CHAPTER 25 PCI TIMING IN ACS

Early Invasive vs. Selectively Invasive Management for Acute Coronary Syndromes

de Winter RJ, Windhausen F, Cornel JH, et al. N Engl J Med. 2005;353:1095–1104

BACKGROUND

Acute Coronary Syndromes (ACS) is a leading cause of mortality and morbidity in the United States and Percutaneous Coronary Intervention (PCI) has been a revolutionary advancement in the treatment of ACS. At the time of this study, guidelines recommend early PCI for patients with ACS without ST-segment elevation and troponinemia; however, clinical trials at the time only provided mixed support for this recommendation due to varied results, different definitions of myocardial infarction, inadequate study methods, and a failure to include other advancements in diagnostic testing and medical therapy such as low-molecular-weight heparins, dual antiplatelet therapy, and high-dose statins.

OBJECTIVES

To test the hypothesis that a general early invasive strategy is superior to a selectively invasive strategy for patients with ACS without ST-segment elevation and/or with an elevated troponin Unstable angina/Non-ST segment elevated myocardial infarction (UA/NSTEMI).

METHODS

Prospective, multicenter randomized control study at 42 Dutch hospitals between 2001 and 2003.

Patients

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