Importance of Risk Assessment in Timing of Invasive Coronary Evaluation and Treatment of Patients With Non–ST‐Segment–Elevation Acute Coronary Syndrome: Insights From the VERDICT Trial
Background The optimal timing of invasive examination and treatment of high‐risk patients with non–ST‐segment–elevation acute coronary syndrome has not been established. We investigated the efficacy of early invasive coronary angiography compared with standard‐care invasive coronary angiography on t...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.022333 |
| _version_ | 1797936135051149312 |
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| author | Jawad H. Butt Klaus F. Kofoed Henning Kelbæk Peter R. Hansen Christian Torp‐Pedersen Dan Høfsten Lene Holmvang Frants Pedersen Lia E. Bang Per E. Sigvardsen Peter Clemmensen Jesper J. Linde Merete Heitmann Jens Dahlgaard Hove Jawdat Abdulla Gunnar Gislason Thomas Engstrøm Lars Køber |
| author_facet | Jawad H. Butt Klaus F. Kofoed Henning Kelbæk Peter R. Hansen Christian Torp‐Pedersen Dan Høfsten Lene Holmvang Frants Pedersen Lia E. Bang Per E. Sigvardsen Peter Clemmensen Jesper J. Linde Merete Heitmann Jens Dahlgaard Hove Jawdat Abdulla Gunnar Gislason Thomas Engstrøm Lars Køber |
| author_sort | Jawad H. Butt |
| collection | DOAJ |
| description | Background The optimal timing of invasive examination and treatment of high‐risk patients with non–ST‐segment–elevation acute coronary syndrome has not been established. We investigated the efficacy of early invasive coronary angiography compared with standard‐care invasive coronary angiography on the risk of all‐cause mortality according to the GRACE (Global Registry of Acute Coronary Events) risk score in a predefined subgroup analysis of the VERDICT (Very Early Versus Deferred Invasive Evaluation Using Computerized Tomography) trial. Methods and Results Patients with clinical suspicion of non–ST‐segment–elevation acute coronary syndrome with ECG changes indicating new ischemia and/or elevated troponin, in whom invasive coronary angiography was clinically indicated and deemed logistically feasible within 12 hours, were eligible for inclusion. Patients were randomized 1:1 to an early (≤12 hours) or standard (48–72 hours) invasive strategy. The primary outcome of the present study was all‐cause mortality. Of 2147 patients randomized in the VERDICT trial, 2092 patients had an available GRACE risk score. Of these, 1021 (48.8%) patients had a GRACE score >140. During a median follow‐up of 4.1 years, 192 (18.8%) and 54 (5.0%) patients died in the high and low GRACE score groups, respectively. The risk of death with the early invasive strategy was increased in patients with a GRACE score ≤140 (hazard ratio [HR], 2.04 [95% CI, 1.16–3.59]), whereas there was a trend toward a decreased risk of death with the early invasive strategy in patients with a GRACE score >140 (HR, 0.83 [95% CI, 0.63–1.10]) (Pinteraction=0.006). Conclusions In patients with non–ST‐segment–elevation acute coronary syndrome, we found a significant interaction between timing of invasive coronary angiography and GRACE score on the risk of death. Randomized clinical trials are warranted to establish the efficacy and safety among high‐risk and low‐risk patients with non–ST‐segment–elevation acute coronary syndrome. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02061891. |
| first_indexed | 2024-04-10T18:25:00Z |
| format | Article |
| id | doaj.art-e18c636949ab4a23b465f854e32cef9a |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-10T18:25:00Z |
| publishDate | 2021-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-e18c636949ab4a23b465f854e32cef9a2023-02-02T06:18:44ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-10-01101910.1161/JAHA.121.022333Importance of Risk Assessment in Timing of Invasive Coronary Evaluation and Treatment of Patients With Non–ST‐Segment–Elevation Acute Coronary Syndrome: Insights From the VERDICT TrialJawad H. Butt0Klaus F. Kofoed1Henning Kelbæk2Peter R. Hansen3Christian Torp‐Pedersen4Dan Høfsten5Lene Holmvang6Frants Pedersen7Lia E. Bang8Per E. Sigvardsen9Peter Clemmensen10Jesper J. Linde11Merete Heitmann12Jens Dahlgaard Hove13Jawdat Abdulla14Gunnar Gislason15Thomas Engstrøm16Lars Køber17Department of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen DenmarkDepartment of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen DenmarkDepartment of Cardiology Zealand University Hospital Roskilde DenmarkDepartment of Cardiology Herlev‐Gentofte University Hospital Hillerød DenmarkDepartment of Clinical Research and Cardiology Nordsjællands Hospital Hillerød DenmarkDepartment of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen DenmarkDepartment of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen DenmarkDepartment of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen DenmarkDepartment of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen DenmarkDepartment of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen DenmarkDepartment of Regional Research, Clinical Institute Faculty of Health Sciences University of Southern Denmark Odense DenmarkDepartment of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen DenmarkDepartment of Cardiology Bispebjerg‐Frederiksberg Hospital Bispebjerg DenmarkDepartment of Cardiology Hvidovre‐Amager Hospital Hvidovre DenmarkDepartment of Cardiology Glostrup Hospital Copenhagen University Hospital Glostrup DenmarkDepartment of Cardiology Herlev‐Gentofte University Hospital Hillerød DenmarkDepartment of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen DenmarkDepartment of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen DenmarkBackground The optimal timing of invasive examination and treatment of high‐risk patients with non–ST‐segment–elevation acute coronary syndrome has not been established. We investigated the efficacy of early invasive coronary angiography compared with standard‐care invasive coronary angiography on the risk of all‐cause mortality according to the GRACE (Global Registry of Acute Coronary Events) risk score in a predefined subgroup analysis of the VERDICT (Very Early Versus Deferred Invasive Evaluation Using Computerized Tomography) trial. Methods and Results Patients with clinical suspicion of non–ST‐segment–elevation acute coronary syndrome with ECG changes indicating new ischemia and/or elevated troponin, in whom invasive coronary angiography was clinically indicated and deemed logistically feasible within 12 hours, were eligible for inclusion. Patients were randomized 1:1 to an early (≤12 hours) or standard (48–72 hours) invasive strategy. The primary outcome of the present study was all‐cause mortality. Of 2147 patients randomized in the VERDICT trial, 2092 patients had an available GRACE risk score. Of these, 1021 (48.8%) patients had a GRACE score >140. During a median follow‐up of 4.1 years, 192 (18.8%) and 54 (5.0%) patients died in the high and low GRACE score groups, respectively. The risk of death with the early invasive strategy was increased in patients with a GRACE score ≤140 (hazard ratio [HR], 2.04 [95% CI, 1.16–3.59]), whereas there was a trend toward a decreased risk of death with the early invasive strategy in patients with a GRACE score >140 (HR, 0.83 [95% CI, 0.63–1.10]) (Pinteraction=0.006). Conclusions In patients with non–ST‐segment–elevation acute coronary syndrome, we found a significant interaction between timing of invasive coronary angiography and GRACE score on the risk of death. Randomized clinical trials are warranted to establish the efficacy and safety among high‐risk and low‐risk patients with non–ST‐segment–elevation acute coronary syndrome. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02061891.https://www.ahajournals.org/doi/10.1161/JAHA.121.022333acute coronary syndromeGRACE scoreheart failureinvasive coronary angiographymortality |
| spellingShingle | Jawad H. Butt Klaus F. Kofoed Henning Kelbæk Peter R. Hansen Christian Torp‐Pedersen Dan Høfsten Lene Holmvang Frants Pedersen Lia E. Bang Per E. Sigvardsen Peter Clemmensen Jesper J. Linde Merete Heitmann Jens Dahlgaard Hove Jawdat Abdulla Gunnar Gislason Thomas Engstrøm Lars Køber Importance of Risk Assessment in Timing of Invasive Coronary Evaluation and Treatment of Patients With Non–ST‐Segment–Elevation Acute Coronary Syndrome: Insights From the VERDICT Trial Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease acute coronary syndrome GRACE score heart failure invasive coronary angiography mortality |
| title | Importance of Risk Assessment in Timing of Invasive Coronary Evaluation and Treatment of Patients With Non–ST‐Segment–Elevation Acute Coronary Syndrome: Insights From the VERDICT Trial |
| title_full | Importance of Risk Assessment in Timing of Invasive Coronary Evaluation and Treatment of Patients With Non–ST‐Segment–Elevation Acute Coronary Syndrome: Insights From the VERDICT Trial |
| title_fullStr | Importance of Risk Assessment in Timing of Invasive Coronary Evaluation and Treatment of Patients With Non–ST‐Segment–Elevation Acute Coronary Syndrome: Insights From the VERDICT Trial |
| title_full_unstemmed | Importance of Risk Assessment in Timing of Invasive Coronary Evaluation and Treatment of Patients With Non–ST‐Segment–Elevation Acute Coronary Syndrome: Insights From the VERDICT Trial |
| title_short | Importance of Risk Assessment in Timing of Invasive Coronary Evaluation and Treatment of Patients With Non–ST‐Segment–Elevation Acute Coronary Syndrome: Insights From the VERDICT Trial |
| title_sort | importance of risk assessment in timing of invasive coronary evaluation and treatment of patients with non st segment elevation acute coronary syndrome insights from the verdict trial |
| topic | acute coronary syndrome GRACE score heart failure invasive coronary angiography mortality |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.022333 |
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