November 21, 2001JAMA
Ability of Minor Elevations of Troponins I and T to Predict Benefit From an Early Invasive Strategy in Patients With Unstable Angina and Non-ST Elevation Myocardial Infarction<SUBTITLE>Results From a Randomized Trial</SUBTITLE>
Why the study?
Does an early invasive strategy reduce the composite of death, MI, or rehospitalization for acute coronary syndrome in patients with unstable angina and non-ST elevation myocardial infarction?
Population
2220 patients with acute coronary syndrome treated with glycoprotein IIb/IIIa inhibitors, across 169…
Comparison
Early invasive strategy of coronary angiography… vs Conservative strategy of medical treatment and…
Design
RCT, randomly assigned
Follow-up
6 months
Authors
Discussion
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Member takes
Implication
Supports early invasive strategy in troponin-positive UA/NSTEMI; extends troponin-guided risk stratification for revascularization decisions.
Structured PICO
Does an early invasive strategy reduce the composite of death, MI, or rehospitalization for acute coronary syndrome in patients with unstable angina and non-ST elevation myocardial infarction?
P
Population
2220 patients with acute coronary syndrome (unstable angina and non-ST-segment elevation myocardial infarction) treated with glycoprotein IIb/IIIa inhibitors, across 169 hospitals in 9 countries.
I
Intervention
Early invasive strategy of coronary angiography between 4 and 48 hours after randomization and revascularization when feasible based on coronary anatomy
C
Comparator
Conservative strategy of medical treatment and, if stable, predischarge exercise tolerance testing (coronary angiography and revascularization only if recurrent ischemia at rest or on provocative testing)
O
Outcome
Composite end point of death, MI, or rehospitalization for acute coronary syndrome at 6 monthscomposite
Even minor elevations in cardiac troponins I and T identify high-risk patients with acute coronary syndrome who derive significant clinical benefit from an early invasive strategy.
Cite This Study
David A. Morrow (2001) studied this question.