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Immediate versus deferred coronary angioplasty in non-ST-elevation acute coronary syndromes
Heart, 12/24/08

Riezebos RK et al. – Immediate PCI was associated with increased rate of myocardial infarction (MI) vs strategy deferred 24-48 hrs, despite aggressive antithrombotic treatment; these findings suggest that PCI for high-risk, non-refractory non-ST-segment elevation (NSTE)-acute coronary syndrome (ACS) should be delayed for at least 24 hours after hospital admission.

• Study of immediate vs deferred angioplasty in NSTE-ACS pts
• Prospective multicenter trial in NSTE-ACS PCI-eligible pts
• Enrollment of 251 pts with acute coronary angiography; coronary anatomy appropriate for PCI in 142 pts
• Randomization to immediate PCI (73 pts) or deferred PCI (24-48 hrs) (69 pts)
• Protocol-driven glycoprotein 2b3a blockers, aspirin, and clopidogrel
• Primary endpoint: composite of death, nonfatal MI or unplanned revascularization at 30 days
• Outpatient follow-up 30 days and 6 mo after discharge

• Primary endpoint incidence at 30 days 60% in immediate PCI pts vs 39% in deferred PCI pts
• MI significantly more frequent in immediate PCI pts (60% vs 37%)
• Observed difference preserved over 6-mo follow up

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