No Advantage to Early Invasive Strategy for NSTEMI

May 25, 2017

Short Attention Span Summary

Clay Smith, MD,  Twitter

Why are they not going to the cath lab?
You may have asked yourself this question while sitting on an NSTEMI patient in the ED.  The ICTUS study looked at whether an early invasive vs selective invasive strategy was better for non-ST elevation acute coronary syndrome with positive troponin (let’s call that NSTEMI, shall we?).  This was the long term, 10-year follow up, which found no difference in the composite outcome of death or spontaneous MI.  If anything, the early intervention group may have fared a bit worse.  So there may be a method to the madness if cardiology isn’t taking someone to the cath lab with an NSTEMI.

Spoon Feed
There was no long-term advantage at 10 years to an early invasive vs selective invasive strategy strategy for NSTEMI.

Source/Another Spoonful
Early Invasive Versus Selective Strategy for Non-ST-Segment Elevation Acute Coronary Syndrome: The ICTUS Trial. J Am Coll Cardiol. 2017 Apr 18;69(15):1883-1893. doi: 10.1016/j.jacc.2017.02.023.

This cardiology blog gives an in depth view and more context for ICTUS.

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Peer Reviewer Comments
Thomas Davis, MD,  Twitter

I totally agree with this synopsis. I’m not surprised to see no difference at 10 years. Most people sick enough to have a heart attack probably aren’t going to do very well 10 years down the road no matter what we do for them.