What does this research mean for the field?

In patients with a first episode of NSTEMI treated with eptifibatide, immediate PCI (≤6 hours) reduces peak markers of myonecrosis compared to early PCI (7-72 hours), without significant differences in myocardial perfusion or microvascular damage. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine whether an immediate invasive strategy compared to an early invasive strategy reduces microvascular damage, infarct size, and improves myocardial perfusion in patients with a first acute non-ST-elevation myocardial infarction.

October 1, 2010Clinical CardiologyOpen Access

Comparison of Immediate vs Early Invasive Strategy in Patients With First Acute Non–ST‐Elevation Myocardial Infarction

Q: What is the clinical evidence from this study?

Study design: RCT. Population: first acute non-ST-elevation myocardial infarction (NSTEMI) (n=54). Intervention: Immediate (≤6 hours) PCI with double bolus eptifibatide vs. Early (7-72 hours) PCI with upstream eptifibatide. Primary outcome: contrast defect length (p=0.56).

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Key result

Immediate PCI in NSTEMI reduces peak CK-MB ~62% versus early PCI, without improving myocardial perfusion.

P=0.56
n=54

Why the study?

The optimal timing for coronary angiography (immediate vs early) in patients with acute NSTEMI remains controversial.

Does immediate PCI with eptifibatide reduce microvascular damage, improve myocardial perfusion, and decrease infarct size compared to early PCI in patients with first NSTEMI?

Population

54 consecutive patients with first episode of NSTEMI

Comparison

Immediate (≤6 hours) PCI with double bolus eptifibatide vs early (7-72 hours) PCI with upstream eptifibatide

Design

Randomized controlled trial

Follow-up

Predischarge

Authors

ASAlessandro SciahbasiOspedale Sandro Pertini MMMariapina MadonnaPoliclinico Casilino MVMaria De VitaInvestigators Research Group (United States)

Discussion

Member takes

Implication

Immediate strategy may limit myonecrosis markers in eptifibatide-treated NSTEMI; hypothesis-generating without perfusion benefit or outcome data.

Key Points

To determine whether an immediate invasive strategy compared to an early invasive strategy reduces microvascular damage, infarct size, and improves myocardial perfusion in patients with a first acute non-ST-elevation myocardial infarction.
Randomized trial including 54 consecutive patients presenting with a first episode of NSTEMI.
Patients were assigned to immediate PCI (≤6 hours, n=27) with a double bolus of eptifibatide or early PCI (7–72 hours, n=27) with upstream eptifibatide.
Myocardial perfusion was assessed using myocardial blush grade (MBG) before and after PCI, and predischarge microvascular damage was evaluated by contrast defect length via myocardial contrast echocardiography alongside peak necrosis biomarkers.
Peak markers of myonecrosis were significantly lower in the immediate PCI arm: creatine kinase myocardial band peaked at 26 ± 26 ng/mL in group A versus 69 ± 79 ng/mL in group B (P = 0.01), and troponin T peaked at 0.84 ± 1.2 ng/mL in group A versus 1.8 ± 2.1 ng/mL in group B (P = 0.048).
Perfusion assessment showed no significant difference in pre-PCI MBG 0 or 1 between group A (41%) and group B (37%, P = 0.78), while post-PCI MBG 0 or 1 was identical at 7.4% in both groups (P = 1.00).
Predischarge contrast defect length was 4.5% in group A compared to 2.8% in group B, showing no statistically significant difference (P = 0.56).

Study Design

Type

RCT (n=54)

Structured PICO

Does immediate PCI with eptifibatide reduce microvascular damage, improve myocardial perfusion, and decrease infarct size compared to early PCI in patients with first NSTEMI?

Population

54 patients with a first episode of NSTEMI randomized to immediate (≤6 hours) versus early (7-72 hours) percutaneous coronary intervention.

Intervention

Immediate (≤6 hours) percutaneous coronary intervention (PCI) with a double bolus of eptifibatide

Comparator

Early (7-72 hours) percutaneous coronary intervention (PCI) with upstream eptifibatide

Outcome

Microvascular damage (contrast defect length by myocardial contrast echocardiography), myocardial perfusion (myocardial blush grade), and infarct size (creatine kinase MB and troponin T peaks) evaluated at predischargesurrogate

Main Result

Absolute Event Rate: 4.5% vs 2.8%

p-value: p=0.56

In patients with first NSTEMI treated with eptifibatide, an immediate invasive strategy (≤6 hours) reduces myonecrosis markers compared to an early strategy (7-72 hours), although it does not significantly improve myocardial perfusion.

Cite This Study

Sciahbasi et al. (2010) conducted an RCT in first acute non-ST-elevation myocardial infarction (NSTEMI) (n=54). Immediate (≤6 hours) PCI with double bolus eptifibatide vs. Early (7-72 hours) PCI with upstream eptifibatide was evaluated on contrast defect length (p=0.56). Immediate PCI (≤6 hours) in NSTEMI patients reduced peak CK-MB (26 vs 69 ng/mL, P=0.01) and Troponin T compared to early PCI, with no significant differences in myocardial perfusion.

synapsesocial.com/papers/6aae0f18b4a3b0d50be0d8ea https://doi.org/10.1002/clc.20785

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Implication

Immediate strategy may limit myonecrosis markers in eptifibatide-treated NSTEMI; hypothesis-generating without perfusion benefit or outcome data.

Comparison of Immediate vs Early Invasive Strategy in Patients With First Acute Non–ST‐Elevation Myocardial Infarction

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Comparison of Immediate vs Early Invasive Strategy in Patients With First Acute Non–ST‐Elevation Myocardial Infarction

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider