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European Heart Journal Advance Access originally published online on November 30, 2004
European Heart Journal 2005 26(2):201; doi:10.1093/eurheartj/ehi047
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European Heart Journal vol. 26 no. 2 © The European Society of Cardiology 2004; all rights reserved.

 

Revascularization for everyone?

David Rott

Hadassah-Hebrew University
Medical Center
Jerusalem, Israel
Tel: +972 2 584 4520
Fax: +972 2 581 2754
E-mail address: drott{at}012.net.il

In a recent editorial, Dr Christopher P. Cannon reviewed the published studies comparing invasive with conservative treatment strategies in patients with non-ST elevation acute coronary syndrome (NSTE-ACS).1 He concluded that it has been very clearly shown that an early invasive approach to all patients with NSTE-ACS is beneficial.

Dr Cannon didn't mention the Invasive versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS) trial. This study was presented at a Hot Line session at the European Society of Cardiology Congress 2004 in Munich, Germany. This study set out to determine whether an early invasive strategy was superior to a more selective strategy in 1200 patients presenting with NSTE-ACS.

Patients were randomly assigned to either an early invasive treatment strategy or a selective strategy. The early invasive strategy included angiography within 24–48 h, percutaneous coronary intervention within 48 h, or coronary bypass surgery as soon as possible; the selective strategy included medical stabilization and angiography, and revascularization only with refractory angina or ischaemia on pre-discharge exercise testing.

Lead ICTUS investigator Robbert de Winter (University of Amsterdam, The Netherlands) reported that the primary composite endpoint of death, myocardial infarction, or ACS re-hospitalization at 1 year occurred similarly in both groups.

This important study implies that all patients with NSTE-ACS should undergo risk stratification assessment and only the high risk patients should promptly be treated invasively, since not all patients with NSTE-ACS would benefit from an early invasive approach.

References

  1. Cannon CP. Revascularization for everyone? Eur Heart J 2004;25:1471–1472.[Free Full Text]

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This Article
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