Key result
Immediate percutaneous coronary intervention did not significantly reduce the 5-year composite of death and spontaneous myocardial infarction compared to deferred intervention in patients with NSTE-ACS (17.8% vs 10.1%; HR 1.55, p=0.21).
Why the study?
Does immediate PCI compared to delayed PCI improve long-term outcomes in patients with intermediate to high risk NSTE-ACS?
RCT (n=142)
Open-label
Yes
Yes
Does immediate PCI compared to delayed PCI improve long-term outcomes in patients with intermediate to high risk NSTE-ACS?
Hazard Ratio: 1.55 (95% CI 0.73–4.22)
Absolute Event Rate: 17.8% vs 10.1%
p-value: p=0.21
Immediate PCI in intermediate to high-risk NSTE-ACS does not reduce the composite of death and spontaneous MI at 5 years compared to delayed PCI, and may increase the risk of spontaneous MI.
Immediate PCI confers no long-term outcome benefit versus deferred in NSTE-ACS; reinforces flexible invasive timing in guidelines.
BACKGROUND: The OPTIMA trial was a randomised multicentre trial exploring the influence of the timing of percutaneous coronary intervention (PCI) on patient outcomes in an intermediate to high risk non-ST-elevation acute coronary syndrome (NSTE-ACS) population. In order to decide the best treatment strategy for patients presenting with NSTE-ACS, long-term outcomes are essential. METHODS: Five-year follow-up data from 133 of the 142 patients could be retrieved (94 %). The primary endpoint was a composite of death and spontaneous myocardial infarction (MI). Spontaneous MI was defined as MI occurring more than 30 days after randomisation. Secondary endpoints were the individual outcomes of death, spontaneous MI or re-PCI. RESULTS: No significant difference with respect to the primary endpoint was observed (17.8 vs. 10.1 %; HR 1.55, 95 % CI: 0.73-4.22, p = 0.21). There was no significant difference in mortality rate. However, spontaneous MI was significantly more common in the group receiving immediate PCI (11.0 vs. 1.4 %; HR 4.46, 95 % CI: 1.21-16.50, p = 0.02). We did not find a significant difference between the groups with respect to re-PCI rate. CONCLUSION: There was no difference in the composite of death and spontaneous MI. The trial suggests an increased long-term risk of spontaneous MI for patients treated with immediate PCI.
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Oosterwerff et al. (2016) conducted an RCT in Non-ST-segment elevation acute coronary syndromes (NSTE-ACS) (n=142). Immediate percutaneous coronary intervention (PCI) vs. Deferred percutaneous coronary intervention (PCI) was evaluated on Composite of death and spontaneous myocardial infarction (MI) (HR 1.55, 95% CI 0.73-4.22, p=0.21). Immediate percutaneous coronary intervention did not significantly reduce the 5-year composite of death and spontaneous myocardial infarction compared to deferred intervention in patients with NSTE-ACS (17.8% vs 10.1%; HR 1.55, p=0.21).
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