The Effect of the Timing of Invasive Management on Cardiac Function in Patients with NSTE-ACS, Insights from the OPTIMA-2 Randomized Controlled Trial
The timing of coronary angiography in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) remains a matter of debate. The relationship between the timing of invasive management and left ventricular function (LVF) is largely unknown. The An Immediate or Early Invasive Strategy in Non-ST...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-08-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/10/16/3636 |
| _version_ | 1797523470670626816 |
|---|---|
| author | Nick D. Fagel Stefan G. J. Leuven Wouter J. Kikkert Michelle M. de Leau Loek van Heerebeek Robert K. Riezebos |
| author_facet | Nick D. Fagel Stefan G. J. Leuven Wouter J. Kikkert Michelle M. de Leau Loek van Heerebeek Robert K. Riezebos |
| author_sort | Nick D. Fagel |
| collection | DOAJ |
| description | The timing of coronary angiography in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) remains a matter of debate. The relationship between the timing of invasive management and left ventricular function (LVF) is largely unknown. The An Immediate or Early Invasive Strategy in Non-ST-Elevation Acute Coronary Syndrome trial (OPTIMA-2) was a randomized controlled prospective open-label multicenter trial that randomized 249 NSTE-ACS patients to either an immediate (<3 h) invasive treatment strategy or an early strategy (12–24 h). Patients were pre-treated with a combination of aspirin, ticagrelor and fondaparinux. The aim of this prespecified sub-analysis was to assess (the recovery of) left ventricular function by analysing echocardiography data obtained <72 h after admission and at 30-day follow-up, for patients with a confirmed diagnosis of acute coronary syndrome. LVF was determined using ejection fraction (EF) and global longitudinal strain (GLS). Inter-observer variability was tested. No difference in the recovery of EF was found between an immediate and early strategy if the follow-up echocardiograms were compared to baseline: 2.5% (standard deviation (SD): 7.9) and 3.3% (SD: 8.5), <i>p</i> = 0.51, nor was there any difference in GLS recovery between the study groups: −0.8% (SD: 2.5) vs. −0.7% (SD 2.8) <i>p</i> = 0.82. If baseline and follow-up echocardiograms were compared, there was a similar but significant improvement in both EF and GLS in both separate study groups. An immediate invasive strategy in NSTE-ACS patients did not result in an improved left ventricular EF or GLS recovery compared with an early strategy. |
| first_indexed | 2024-03-10T08:42:26Z |
| format | Article |
| id | doaj.art-eb44b38736b44d33b43f349c8b4abcba |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T08:42:26Z |
| publishDate | 2021-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-eb44b38736b44d33b43f349c8b4abcba2023-11-22T08:11:15ZengMDPI AGJournal of Clinical Medicine2077-03832021-08-011016363610.3390/jcm10163636The Effect of the Timing of Invasive Management on Cardiac Function in Patients with NSTE-ACS, Insights from the OPTIMA-2 Randomized Controlled TrialNick D. Fagel0Stefan G. J. Leuven1Wouter J. Kikkert2Michelle M. de Leau3Loek van Heerebeek4Robert K. Riezebos5Heart Center, Department of Cardiology, OLVG Hospital, 1091 AC Amsterdam, The NetherlandsHeart Center, Department of Cardiology, OLVG Hospital, 1091 AC Amsterdam, The NetherlandsHeart Center, Department of Cardiology, OLVG Hospital, 1091 AC Amsterdam, The NetherlandsHeart Center, Department of Cardiology, OLVG Hospital, 1091 AC Amsterdam, The NetherlandsHeart Center, Department of Cardiology, OLVG Hospital, 1091 AC Amsterdam, The NetherlandsHeart Center, Department of Cardiology, OLVG Hospital, 1091 AC Amsterdam, The NetherlandsThe timing of coronary angiography in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) remains a matter of debate. The relationship between the timing of invasive management and left ventricular function (LVF) is largely unknown. The An Immediate or Early Invasive Strategy in Non-ST-Elevation Acute Coronary Syndrome trial (OPTIMA-2) was a randomized controlled prospective open-label multicenter trial that randomized 249 NSTE-ACS patients to either an immediate (<3 h) invasive treatment strategy or an early strategy (12–24 h). Patients were pre-treated with a combination of aspirin, ticagrelor and fondaparinux. The aim of this prespecified sub-analysis was to assess (the recovery of) left ventricular function by analysing echocardiography data obtained <72 h after admission and at 30-day follow-up, for patients with a confirmed diagnosis of acute coronary syndrome. LVF was determined using ejection fraction (EF) and global longitudinal strain (GLS). Inter-observer variability was tested. No difference in the recovery of EF was found between an immediate and early strategy if the follow-up echocardiograms were compared to baseline: 2.5% (standard deviation (SD): 7.9) and 3.3% (SD: 8.5), <i>p</i> = 0.51, nor was there any difference in GLS recovery between the study groups: −0.8% (SD: 2.5) vs. −0.7% (SD 2.8) <i>p</i> = 0.82. If baseline and follow-up echocardiograms were compared, there was a similar but significant improvement in both EF and GLS in both separate study groups. An immediate invasive strategy in NSTE-ACS patients did not result in an improved left ventricular EF or GLS recovery compared with an early strategy.https://www.mdpi.com/2077-0383/10/16/3636acute coronary syndrometimingtreatment strategyechocardiographyglobal longitudinal strain |
| spellingShingle | Nick D. Fagel Stefan G. J. Leuven Wouter J. Kikkert Michelle M. de Leau Loek van Heerebeek Robert K. Riezebos The Effect of the Timing of Invasive Management on Cardiac Function in Patients with NSTE-ACS, Insights from the OPTIMA-2 Randomized Controlled Trial Journal of Clinical Medicine acute coronary syndrome timing treatment strategy echocardiography global longitudinal strain |
| title | The Effect of the Timing of Invasive Management on Cardiac Function in Patients with NSTE-ACS, Insights from the OPTIMA-2 Randomized Controlled Trial |
| title_full | The Effect of the Timing of Invasive Management on Cardiac Function in Patients with NSTE-ACS, Insights from the OPTIMA-2 Randomized Controlled Trial |
| title_fullStr | The Effect of the Timing of Invasive Management on Cardiac Function in Patients with NSTE-ACS, Insights from the OPTIMA-2 Randomized Controlled Trial |
| title_full_unstemmed | The Effect of the Timing of Invasive Management on Cardiac Function in Patients with NSTE-ACS, Insights from the OPTIMA-2 Randomized Controlled Trial |
| title_short | The Effect of the Timing of Invasive Management on Cardiac Function in Patients with NSTE-ACS, Insights from the OPTIMA-2 Randomized Controlled Trial |
| title_sort | effect of the timing of invasive management on cardiac function in patients with nste acs insights from the optima 2 randomized controlled trial |
| topic | acute coronary syndrome timing treatment strategy echocardiography global longitudinal strain |
| url | https://www.mdpi.com/2077-0383/10/16/3636 |
| work_keys_str_mv | AT nickdfagel theeffectofthetimingofinvasivemanagementoncardiacfunctioninpatientswithnsteacsinsightsfromtheoptima2randomizedcontrolledtrial AT stefangjleuven theeffectofthetimingofinvasivemanagementoncardiacfunctioninpatientswithnsteacsinsightsfromtheoptima2randomizedcontrolledtrial AT wouterjkikkert theeffectofthetimingofinvasivemanagementoncardiacfunctioninpatientswithnsteacsinsightsfromtheoptima2randomizedcontrolledtrial AT michellemdeleau theeffectofthetimingofinvasivemanagementoncardiacfunctioninpatientswithnsteacsinsightsfromtheoptima2randomizedcontrolledtrial AT loekvanheerebeek theeffectofthetimingofinvasivemanagementoncardiacfunctioninpatientswithnsteacsinsightsfromtheoptima2randomizedcontrolledtrial AT robertkriezebos theeffectofthetimingofinvasivemanagementoncardiacfunctioninpatientswithnsteacsinsightsfromtheoptima2randomizedcontrolledtrial AT nickdfagel effectofthetimingofinvasivemanagementoncardiacfunctioninpatientswithnsteacsinsightsfromtheoptima2randomizedcontrolledtrial AT stefangjleuven effectofthetimingofinvasivemanagementoncardiacfunctioninpatientswithnsteacsinsightsfromtheoptima2randomizedcontrolledtrial AT wouterjkikkert effectofthetimingofinvasivemanagementoncardiacfunctioninpatientswithnsteacsinsightsfromtheoptima2randomizedcontrolledtrial AT michellemdeleau effectofthetimingofinvasivemanagementoncardiacfunctioninpatientswithnsteacsinsightsfromtheoptima2randomizedcontrolledtrial AT loekvanheerebeek effectofthetimingofinvasivemanagementoncardiacfunctioninpatientswithnsteacsinsightsfromtheoptima2randomizedcontrolledtrial AT robertkriezebos effectofthetimingofinvasivemanagementoncardiacfunctioninpatientswithnsteacsinsightsfromtheoptima2randomizedcontrolledtrial |