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RIDDLE-NSTEMI: Immediate intervention better than delayed in patients with non-STEMI
In patients with non-STEMI, an immediate invasive strategy reduced risk for death or new MI compared with a delayed invasive strategy, according to new research.
Researchers conducted a randomized controlled trial of 323 patients with non-STEMI at a single center to determine a difference in outcomes for immediate intervention vs. delayed intervention; previous research was inconsistent.
“The question of optimal timing remains unsolved, balancing the risks of intervening on an unstable plaque and the risk of new ischemic events while waiting for the invasive procedure,” Aleksandra Milosevic, MD, and colleagues wrote.
Patients were assigned immediate intervention, in which they were transferred for angiography as soon as possible, less than 2 hours after randomization; or delayed intervention, in which they were transferred for angiography 2 to 72 hours after randomization, unless they had chest pain, recurrent ischemia or otherwise became clinically unstable while waiting.
The primary endpoint was death or new MI at 30 days.
Median time from randomization to angiography was 1.4 hours in the immediate-intervention group (n = 162) and 61 hours in the delayed-intervention group (n = 161).
At 30 days, the rate of death or new MI was 4.3% in the immediate-intervention group and 13% in the delayed-intervention group (HR = 0.32; 95% CI, 0.13-0.74), Milosevic, from the department of cardiology, Clinical Center of Serbia, Belgrade, Serbia, and colleagues wrote.
The curves for the primary outcome remained separated at 1 year (immediate, 6.8%; delayed, 18.8%; HR = 0.34; 95% CI, 0.17-0.67).
They wrote that the main driver of the results was new MI in the waiting period before catheterization (0 in immediate group, 10 in delayed group). One patient from the delayed group died during this period.
The researchers also found that the rate of death, new MI or recurrent ischemia was lower in the immediate-intervention group at 30 days (6.8% vs. 26.7%; P < .001) and 1 year (15.4% vs. 33.1%; P < .001).
“Future studies with standardized protocols that include a clinically oriented definition of periprocedural MI, larger sample size and longer-term follow-up are needed to assess the true effect of immediate intervention in [patients with non-STEMI],” they wrote. – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.