Immediate Versus Delayed Invasive Intervention for Non STEMI Patients: The RIDDLE NSTEMI Study.
OBJECTIVES This study aimed to assess the clinical impact of immediate versus delayed invasive intervention in patients with non ST segment myocardial infarction (NSTEMI) BACKGROUND Previous studies found conflicting results on the effects of earlier invasive intervention in a heterogeneous population of acute coronary syndromes without ST segment elevation. METHODS We randomized 323 NSTEMI patients to an immediate intervention group <2 h after randomization, n 162) and a delayed intervention group (2 to 72 h, n 161).The primary endpoint was the occurrence of death or new myocardial infarction (MI) at 30 day follow up. RESULTS Median time from randomization to angiography was 1.4 h and 61.0 h in the immediate intervention group and the delayed intervention group, respectively (p 0.001) At 30 days, the primary endpoint was achieved less frequently in patients undergoing immediate intervention (4.3% vs. 13% hazard ratio: 0.32, 95% confidence interval: 0.13 to 0.74; p 0.008) At 1 year, this difference persisted (6.8% in the immediate intervention group vs. 18.8% in delayed intervention group; hazard ratio: 0.34, 95% confidence interval: 0.17 to 0.67; p 0.002) The observed results were mainly attributable to the occurrence of new MI in the pre catheterization period (0 deaths 0 MIs in the immediate intervention group vs. 1 death 10 MIs in the delayed intervention group) The rate of deaths, new MI, or recurrent ischemia was lower in the immediate intervention group at both 30 days (6.8% vs. 26.7% p 0.001) and 1 year (15.4% vs. 33.1% p 0.001) CONCLUSIONS Immediate invasive strategy in NSTEMI patients is associated with lower rates of death or new MI compared with the delayed invasive strategy at early and midterm follow up, mainly due to a decrease in the risk of new MI in the pre catheterization period. (Immediate Versus Delayed Invasive Intervention for Non STEMI Patients [RIDDLE NSTEMI] NCT02419833)
JACC. Cardiovascular interventions