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Three-Year Impact of Immediate Invasive Strategy in Patients With Non-ST-Segment Elevation Myocardial Infarction

Dejan Milasinovic1, Aleksandra Milosevic2, Zorana Vasiljevic-Pokrajcic3

  • 1Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.

The American Journal of Cardiology
|April 30, 2018
PubMed

Insights

Immediate invasive intervention for Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) reduces early death or new myocardial infarction (MI) risk. Long-term outcomes beyond 30 days are similar, influenced by baseline risk, not intervention timing.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Coronary Syndromes

Background:

  • Long-term outcomes of early vs. delayed invasive strategies in Non-ST-Elevation Myocardial Infarction (NSTEMI) are not well-established.
  • Previous studies offer limited long-term follow-up data for NSTEMI interventions.

Purpose of the Study:

  • To evaluate the long-term effects of immediate invasive intervention in NSTEMI patients.
  • To compare clinical outcomes between immediate and delayed invasive strategies up to 3-year follow-up.

Main Methods:

  • The study randomized 323 NSTEMI patients to either immediate (median 1.4 hours) or delayed (61.0 hours) invasive intervention.
  • The primary endpoint was the composite of death or new myocardial infarction (MI) over 3 years.
  • The Randomized Study of Immediate Versus Delayed Invasive Intervention in Patients With Non-ST-Segment Elevation Myocardial Infarction (RIDDLE-NSTEMI) trial design was used.

Main Results:

  • Immediate intervention significantly reduced the composite of death or new MI at 3 years (12.3% vs. 22.5%, HR 0.50, p=0.014).
  • The benefit was driven by reduced early reinfarction in the immediate group; new MI rates were similar beyond 30 days.
  • Three-year mortality rates were comparable (9.3% vs. 10.0%, p=0.83).

Conclusions:

  • Immediate invasive intervention in NSTEMI reduces early risk of death or new MI.
  • Intervention timing showed no significant impact on clinical outcomes beyond 30 days.
  • Baseline risk profile, indicated by high Global Registry of Acute Coronary Events score, significantly impacts long-term mortality regardless of intervention timing.

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