Early versus Delayed Invasive Intervention in Acute Coronary Syndromes
In patients with acute coronary syndromes, early invasive intervention (coronary angiography at a median of 14 hours) was compared with delayed intervention (angiography at a median of 50 hours). There was no difference in outcomes between the two groups overall, but high-risk patients had better ou...
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| Veröffentlicht in: | The New England journal of medicine 2009-05, Vol.360 (21), p.2165-2175 |
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| creator | Mehta, Shamir R Granger, Christopher B Boden, William E Steg, Philippe Gabriel Bassand, Jean-Pierre Faxon, David P Afzal, Rizwan Chrolavicius, Susan Jolly, Sanjit S Widimsky, Petr Avezum, Alvaro Rupprecht, Hans-Jurgen Zhu, Jun Col, Jacques Natarajan, Madhu K Horsman, Craig Fox, Keith A.A Yusuf, Salim |
| description | In patients with acute coronary syndromes, early invasive intervention (coronary angiography at a median of 14 hours) was compared with delayed intervention (angiography at a median of 50 hours). There was no difference in outcomes between the two groups overall, but high-risk patients had better outcomes with the early strategy and in particular had less risk of refractory ischemia.
There was no difference in outcomes between the two groups overall, but high-risk patients had better outcomes with the early strategy and in particular had less risk of refractory ischemia.
Randomized trials have shown that a routine invasive strategy is beneficial in high-risk patients with acute coronary syndromes.
1
–
3
In patients with myocardial infarction with ST-segment elevation, in which the infarct-related artery is usually occluded and there is ongoing transmural ischemia, it is well established that the earlier primary percutaneous coronary intervention (PCI) can be performed, the lower the mortality.
4
,
5
By contrast, in patients with acute coronary syndromes without ST-segment elevation (including unstable angina and myocardial infarction), the culprit artery is often patent, there is usually no ongoing transmural ischemia, and the patient often has a good response to . . . |
| doi_str_mv | 10.1056/NEJMoa0807986 |
| format | Article |
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There was no difference in outcomes between the two groups overall, but high-risk patients had better outcomes with the early strategy and in particular had less risk of refractory ischemia.
Randomized trials have shown that a routine invasive strategy is beneficial in high-risk patients with acute coronary syndromes.
1
–
3
In patients with myocardial infarction with ST-segment elevation, in which the infarct-related artery is usually occluded and there is ongoing transmural ischemia, it is well established that the earlier primary percutaneous coronary intervention (PCI) can be performed, the lower the mortality.
4
,
5
By contrast, in patients with acute coronary syndromes without ST-segment elevation (including unstable angina and myocardial infarction), the culprit artery is often patent, there is usually no ongoing transmural ischemia, and the patient often has a good response to . . .</description><identifier>ISSN: 0028-4793</identifier><identifier>EISSN: 1533-4406</identifier><identifier>DOI: 10.1056/NEJMoa0807986</identifier><identifier>PMID: 19458363</identifier><identifier>CODEN: NEJMAG</identifier><language>eng</language><publisher>Waltham, MA: Massachusetts Medical Society</publisher><subject>Acute Coronary Syndrome - diagnostic imaging ; Acute Coronary Syndrome - mortality ; Acute Coronary Syndrome - therapy ; Acute coronary syndromes ; Aged ; Angina pectoris ; Angina Pectoris - therapy ; Angioplasty, Balloon, Coronary ; Biological and medical sciences ; Cardiology. Vascular system ; Coronary Angiography ; Coronary Artery Bypass ; Coronary heart disease ; Early intervention ; Female ; General aspects ; Health sciences ; Heart ; Heart attacks ; Humans ; Ischemia ; Kaplan-Meier Estimate ; Male ; Medical imaging ; Medical research ; Medical sciences ; Middle Aged ; Myocardial Infarction - epidemiology ; Myocardial Infarction - prevention & control ; Myocardial Infarction - therapy ; Outcome Assessment (Health Care) ; Risk ; Stroke - epidemiology ; Stroke - prevention & control ; Time Factors</subject><ispartof>The New England journal of medicine, 2009-05, Vol.360 (21), p.2165-2175</ispartof><rights>Copyright © 2009 Massachusetts Medical Society. All rights reserved.</rights><rights>2009 INIST-CNRS</rights><rights>2009 Massachusetts Medical Society</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c508t-d9bf3121fced345f3f0a0797ebf4e788d68498ffec85d28a54f82e577a016a913</citedby><cites>FETCH-LOGICAL-c508t-d9bf3121fced345f3f0a0797ebf4e788d68498ffec85d28a54f82e577a016a913</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.nejm.org/doi/pdf/10.1056/NEJMoa0807986$$EPDF$$P50$$Gmms$$H</linktopdf><linktohtml>$$Uhttps://www.nejm.org/doi/full/10.1056/NEJMoa0807986$$EHTML$$P50$$Gmms$$H</linktohtml><link.rule.ids>314,776,780,2746,2747,26080,27901,27902,52357,54039</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21492151$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19458363$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mehta, Shamir R</creatorcontrib><creatorcontrib>Granger, Christopher B</creatorcontrib><creatorcontrib>Boden, William E</creatorcontrib><creatorcontrib>Steg, Philippe Gabriel</creatorcontrib><creatorcontrib>Bassand, Jean-Pierre</creatorcontrib><creatorcontrib>Faxon, David P</creatorcontrib><creatorcontrib>Afzal, Rizwan</creatorcontrib><creatorcontrib>Chrolavicius, Susan</creatorcontrib><creatorcontrib>Jolly, Sanjit S</creatorcontrib><creatorcontrib>Widimsky, Petr</creatorcontrib><creatorcontrib>Avezum, Alvaro</creatorcontrib><creatorcontrib>Rupprecht, Hans-Jurgen</creatorcontrib><creatorcontrib>Zhu, Jun</creatorcontrib><creatorcontrib>Col, Jacques</creatorcontrib><creatorcontrib>Natarajan, Madhu K</creatorcontrib><creatorcontrib>Horsman, Craig</creatorcontrib><creatorcontrib>Fox, Keith A.A</creatorcontrib><creatorcontrib>Yusuf, Salim</creatorcontrib><creatorcontrib>TIMACS Investigators</creatorcontrib><title>Early versus Delayed Invasive Intervention in Acute Coronary Syndromes</title><title>The New England journal of medicine</title><addtitle>N Engl J Med</addtitle><description>In patients with acute coronary syndromes, early invasive intervention (coronary angiography at a median of 14 hours) was compared with delayed intervention (angiography at a median of 50 hours). There was no difference in outcomes between the two groups overall, but high-risk patients had better outcomes with the early strategy and in particular had less risk of refractory ischemia.
There was no difference in outcomes between the two groups overall, but high-risk patients had better outcomes with the early strategy and in particular had less risk of refractory ischemia.
Randomized trials have shown that a routine invasive strategy is beneficial in high-risk patients with acute coronary syndromes.
1
–
3
In patients with myocardial infarction with ST-segment elevation, in which the infarct-related artery is usually occluded and there is ongoing transmural ischemia, it is well established that the earlier primary percutaneous coronary intervention (PCI) can be performed, the lower the mortality.
4
,
5
By contrast, in patients with acute coronary syndromes without ST-segment elevation (including unstable angina and myocardial infarction), the culprit artery is often patent, there is usually no ongoing transmural ischemia, and the patient often has a good response to . . .</description><subject>Acute Coronary Syndrome - diagnostic imaging</subject><subject>Acute Coronary Syndrome - mortality</subject><subject>Acute Coronary Syndrome - therapy</subject><subject>Acute coronary syndromes</subject><subject>Aged</subject><subject>Angina pectoris</subject><subject>Angina Pectoris - therapy</subject><subject>Angioplasty, Balloon, Coronary</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Coronary Angiography</subject><subject>Coronary Artery Bypass</subject><subject>Coronary heart disease</subject><subject>Early intervention</subject><subject>Female</subject><subject>General aspects</subject><subject>Health sciences</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - epidemiology</subject><subject>Myocardial Infarction - prevention & control</subject><subject>Myocardial Infarction - therapy</subject><subject>Outcome Assessment (Health Care)</subject><subject>Risk</subject><subject>Stroke - epidemiology</subject><subject>Stroke - prevention & control</subject><subject>Time Factors</subject><issn>0028-4793</issn><issn>1533-4406</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp10E1LwzAYB_AgipvTo1cpgt6qeW2T45ibL0w9qOeStU-go01m0g727Y1sOBTMIcnhx_PyR-ic4BuCRXb7Mn16dhpLnCuZHaAhEYylnOPsEA0xpjLluWIDdBLCEsdDuDpGA6K4kCxjQzSbat9skjX40IfkDhq9gSp5tGsd6jXETwd-DbarnU1qm4zLvoNk4ryz2m-St42tvGshnKIjo5sAZ7t3hD5m0_fJQzp_vX-cjOdpKbDs0kotDCOUmBIqxoVhBus4eA4LwyGXssokV9IYKKWoqNSCG0lB5LnGJNOKsBG63tZdeffZQ-iKtg4lNI224PpQZDnNMM1xhJd_4NL13sbZCkqZwipeEaVbVHoXggdTrHzdxsUKgovvdItf6UZ_sSvaL1qo9noXZwRXO6BDqRvjtS3r8ONoTJ8SQfaubUNhYdn-0_ALvzuM6w</recordid><startdate>20090521</startdate><enddate>20090521</enddate><creator>Mehta, Shamir R</creator><creator>Granger, Christopher B</creator><creator>Boden, William E</creator><creator>Steg, Philippe Gabriel</creator><creator>Bassand, Jean-Pierre</creator><creator>Faxon, David P</creator><creator>Afzal, Rizwan</creator><creator>Chrolavicius, Susan</creator><creator>Jolly, Sanjit S</creator><creator>Widimsky, Petr</creator><creator>Avezum, Alvaro</creator><creator>Rupprecht, Hans-Jurgen</creator><creator>Zhu, Jun</creator><creator>Col, Jacques</creator><creator>Natarajan, Madhu K</creator><creator>Horsman, Craig</creator><creator>Fox, Keith A.A</creator><creator>Yusuf, Salim</creator><general>Massachusetts Medical Society</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TZ</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K0Y</scope><scope>LK8</scope><scope>M0R</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQGLB</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20090521</creationdate><title>Early versus Delayed Invasive Intervention in Acute Coronary Syndromes</title><author>Mehta, Shamir R ; Granger, Christopher B ; Boden, William E ; Steg, Philippe Gabriel ; Bassand, Jean-Pierre ; Faxon, David P ; Afzal, Rizwan ; Chrolavicius, Susan ; Jolly, Sanjit S ; Widimsky, Petr ; Avezum, Alvaro ; Rupprecht, Hans-Jurgen ; Zhu, Jun ; Col, Jacques ; Natarajan, Madhu K ; Horsman, Craig ; Fox, Keith A.A ; Yusuf, Salim</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c508t-d9bf3121fced345f3f0a0797ebf4e788d68498ffec85d28a54f82e577a016a913</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Acute Coronary Syndrome - diagnostic imaging</topic><topic>Acute Coronary Syndrome - mortality</topic><topic>Acute Coronary Syndrome - therapy</topic><topic>Acute coronary syndromes</topic><topic>Aged</topic><topic>Angina pectoris</topic><topic>Angina Pectoris - therapy</topic><topic>Angioplasty, Balloon, Coronary</topic><topic>Biological and medical sciences</topic><topic>Cardiology. 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Academic</collection><jtitle>The New England journal of medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mehta, Shamir R</au><au>Granger, Christopher B</au><au>Boden, William E</au><au>Steg, Philippe Gabriel</au><au>Bassand, Jean-Pierre</au><au>Faxon, David P</au><au>Afzal, Rizwan</au><au>Chrolavicius, Susan</au><au>Jolly, Sanjit S</au><au>Widimsky, Petr</au><au>Avezum, Alvaro</au><au>Rupprecht, Hans-Jurgen</au><au>Zhu, Jun</au><au>Col, Jacques</au><au>Natarajan, Madhu K</au><au>Horsman, Craig</au><au>Fox, Keith A.A</au><au>Yusuf, Salim</au><aucorp>TIMACS Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early versus Delayed Invasive Intervention in Acute Coronary Syndromes</atitle><jtitle>The New England journal of medicine</jtitle><addtitle>N Engl J Med</addtitle><date>2009-05-21</date><risdate>2009</risdate><volume>360</volume><issue>21</issue><spage>2165</spage><epage>2175</epage><pages>2165-2175</pages><issn>0028-4793</issn><eissn>1533-4406</eissn><coden>NEJMAG</coden><abstract>In patients with acute coronary syndromes, early invasive intervention (coronary angiography at a median of 14 hours) was compared with delayed intervention (angiography at a median of 50 hours). There was no difference in outcomes between the two groups overall, but high-risk patients had better outcomes with the early strategy and in particular had less risk of refractory ischemia.
There was no difference in outcomes between the two groups overall, but high-risk patients had better outcomes with the early strategy and in particular had less risk of refractory ischemia.
Randomized trials have shown that a routine invasive strategy is beneficial in high-risk patients with acute coronary syndromes.
1
–
3
In patients with myocardial infarction with ST-segment elevation, in which the infarct-related artery is usually occluded and there is ongoing transmural ischemia, it is well established that the earlier primary percutaneous coronary intervention (PCI) can be performed, the lower the mortality.
4
,
5
By contrast, in patients with acute coronary syndromes without ST-segment elevation (including unstable angina and myocardial infarction), the culprit artery is often patent, there is usually no ongoing transmural ischemia, and the patient often has a good response to . . .</abstract><cop>Waltham, MA</cop><pub>Massachusetts Medical Society</pub><pmid>19458363</pmid><doi>10.1056/NEJMoa0807986</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | The New England journal of medicine, 2009-05, Vol.360 (21), p.2165-2175 |
| issn | 0028-4793 1533-4406 |
| language | eng |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; New England Journal of Medicine |
| subjects | Acute Coronary Syndrome - diagnostic imaging Acute Coronary Syndrome - mortality Acute Coronary Syndrome - therapy Acute coronary syndromes Aged Angina pectoris Angina Pectoris - therapy Angioplasty, Balloon, Coronary Biological and medical sciences Cardiology. Vascular system Coronary Angiography Coronary Artery Bypass Coronary heart disease Early intervention Female General aspects Health sciences Heart Heart attacks Humans Ischemia Kaplan-Meier Estimate Male Medical imaging Medical research Medical sciences Middle Aged Myocardial Infarction - epidemiology Myocardial Infarction - prevention & control Myocardial Infarction - therapy Outcome Assessment (Health Care) Risk Stroke - epidemiology Stroke - prevention & control Time Factors |
| title | Early versus Delayed Invasive Intervention in Acute Coronary Syndromes |
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