TY - JOUR
T1 - Early Invasive Versus Selective Strategy for Non-ST-Segment Elevation Acute Coronary Syndrome: The ICTUS Trial
AU - Hoedemaker, Niels P. G.
AU - Damman, Peter
AU - Woudstra, Pier
AU - Hirsch, Alexander
AU - Windhausen, Fons
AU - Tijssen, Jan G. P.
AU - de Winter, Robbert J.
AU - AUTHOR GROUP
AU - Peters, R. J. G.
AU - Dunselman, P. H. J. M.
AU - Verheugt, F. W. A.
AU - Janus, C. L.
AU - Umans, V.
AU - Bendermacher, P. E. F.
AU - Michels, H. R.
AU - Sade, A.
AU - Hertzberger, D.
AU - de Miliano, P. A. R. M.
AU - Liem, A. H.
AU - Tjon Joe Gin, R.
AU - van der Linde, M.
AU - Lok, D.
AU - Hoedemaker, G.
AU - Pieterse, M.
AU - van den Merkhof, L.
AU - Daniels, M.
AU - van Hessen, M.
AU - Hermans, W.
AU - Schotborgh, C. E.
AU - de Zwaan, C.
AU - Bredero, A.
AU - de Jaegere, P.
AU - Janssen, M.
AU - Louwerenburg, J.
AU - Veerhoek, M.
AU - Schalij, M.
AU - de Porto, A.
AU - Zijlstra, F.
AU - Winter, J.
AU - de Feyter, P.
AU - Robles de Medina, R.
AU - Withagen, P.
AU - Sedney, M.
AU - Thijssen, H.
AU - van Rees, C.
AU - van den Bergh, P.
AU - de Cock, C.
AU - van 't Hof, A.
AU - Suttorp, M. J.
AU - Windhausen, F.
AU - Cornel, J. H.
PY - 2017
Y1 - 2017
N2 - The ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes) trial compared early invasive strategy with a selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and an elevated cardiac troponin T. No long-term benefit of an early invasive strategy was found at 1 and 5 years. The aim of this study was to determine the 10-year clinical outcomes of an early invasive strategy versus a selective invasive strategy in patients with NSTE-ACS and an elevated cardiac troponin T. The ICTUS trial was a multicenter, randomized controlled clinical trial that included 1,200 patients with NSTE-ACS and an elevated cardiac troponin T. Enrollment was from July 2001 to August 2003. We collected 10-year follow-up of death, myocardial infarction (MI), and revascularization through the Dutch population registry, patient phone calls, general practitioners, and hospital records. The primary outcome was the 10-year composite of death or spontaneous MI. Additional outcomes included the composite of death or MI, death, MI (spontaneous and procedure-related), and revascularization. Ten-year death or spontaneous MI was not statistically different between the 2 groups (33.8% vs. 29.0%, hazard ratio [HR]: 1.12; 95% confidence interval [CI]: 0.97 to 1.46; p = 0.11). Revascularization occurred in 82.6% of the early invasive group and 60.5% in the selective invasive group. There were no differences in additional outcomes, except for a higher rate of death or MI in the early invasive group compared with the rates for the selective invasive group (37.6% vs. 30.5%; HR: 1.30; 95% CI: 1.07 to 1.58; p = 0.009), driven by a higher rate of procedure-related MI in the early invasive group (6.5% vs. 2.4%; HR: 2.82; 95% CI: 1.53 to 5.20; p = 0.001). In patients with NSTE-ACS and elevated cardiac troponin T levels, an early invasive strategy has no benefit over a selective invasive strategy in reducing the 10-year composite outcome of death or spontaneous MI, and a selective invasive strategy may be a viable option in selected patients
AB - The ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes) trial compared early invasive strategy with a selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and an elevated cardiac troponin T. No long-term benefit of an early invasive strategy was found at 1 and 5 years. The aim of this study was to determine the 10-year clinical outcomes of an early invasive strategy versus a selective invasive strategy in patients with NSTE-ACS and an elevated cardiac troponin T. The ICTUS trial was a multicenter, randomized controlled clinical trial that included 1,200 patients with NSTE-ACS and an elevated cardiac troponin T. Enrollment was from July 2001 to August 2003. We collected 10-year follow-up of death, myocardial infarction (MI), and revascularization through the Dutch population registry, patient phone calls, general practitioners, and hospital records. The primary outcome was the 10-year composite of death or spontaneous MI. Additional outcomes included the composite of death or MI, death, MI (spontaneous and procedure-related), and revascularization. Ten-year death or spontaneous MI was not statistically different between the 2 groups (33.8% vs. 29.0%, hazard ratio [HR]: 1.12; 95% confidence interval [CI]: 0.97 to 1.46; p = 0.11). Revascularization occurred in 82.6% of the early invasive group and 60.5% in the selective invasive group. There were no differences in additional outcomes, except for a higher rate of death or MI in the early invasive group compared with the rates for the selective invasive group (37.6% vs. 30.5%; HR: 1.30; 95% CI: 1.07 to 1.58; p = 0.009), driven by a higher rate of procedure-related MI in the early invasive group (6.5% vs. 2.4%; HR: 2.82; 95% CI: 1.53 to 5.20; p = 0.001). In patients with NSTE-ACS and elevated cardiac troponin T levels, an early invasive strategy has no benefit over a selective invasive strategy in reducing the 10-year composite outcome of death or spontaneous MI, and a selective invasive strategy may be a viable option in selected patients
U2 - https://doi.org/10.1016/j.jacc.2017.02.023
DO - https://doi.org/10.1016/j.jacc.2017.02.023
M3 - Article
C2 - 28408018
SN - 0735-1097
VL - 69
SP - 1883
EP - 1893
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 15
ER -