Document Detail

5-year clinical outcomes in the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial a randomized comparison of an early invasive versus selective invasive management in patients with non-ST-segment elevation acute coronary syndrome.
MedLine Citation:
PMID:  20045278     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We present the 5-year clinical outcomes according to treatment strategy with additional risk stratification of the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial.
BACKGROUND: Long-term outcomes may be relevant to decide treatment strategy for patients presenting with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and elevated troponin T.
METHODS: We randomly assigned 1,200 patients to an early invasive or selective invasive strategy. The outcomes were the composite of death or myocardial infarction (MI) and its individual components. Risk stratification was performed with the FRISC (Fast Revascularization in InStability in Coronary artery disease) risk score.
RESULTS: At 5-year follow-up, revascularization rates were 81% in the early invasive and 60% in the selective invasive group. Cumulative death or MI rates were 22.3% and 18.1%, respectively (hazard ratio [HR]: 1.29, 95% confidence interval [CI]: 1.00 to 1.66, p = 0.053). No difference was observed in mortality (HR: 1.13, 95% CI: 0.80 to 1.60, p = 0.49) or MI (HR: 1.24, 95% CI: 0.90 to 1.70, p = 0.20). After risk stratification, no benefit of an early invasive strategy was observed in reducing death or spontaneous MI in any of the risk groups.
CONCLUSIONS: In patients presenting with NSTE-ACS and elevated troponin T, we could not demonstrate a long-term benefit of an early invasive strategy in reducing death or MI. (Invasive versus Conservative Treatment in Unstable coronary Syndromes [ICTUS]; ISRCTN82153174).
Peter Damman; Alexander Hirsch; Fons Windhausen; Jan G P Tijssen; Robbert J de Winter;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial     Date:  2010-01-04
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  55     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-02-26     Completed Date:  2010-03-25     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  858-64     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Department of Cardiology, Cardiac Catheterization Laboratory B2-137, Academic Medical Center-University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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MeSH Terms
Acute Coronary Syndrome / diagnosis,  mortality,  therapy*
Aged, 80 and over
Angina, Unstable / diagnosis,  mortality,  therapy*
Antibodies, Monoclonal / therapeutic use
Aspirin / therapeutic use
Coronary Angiography
Enoxaparin / therapeutic use
Fibrinolytic Agents / therapeutic use*
Follow-Up Studies
Immunoglobulin Fab Fragments / therapeutic use
Middle Aged
Myocardial Revascularization / methods*
Netherlands / epidemiology
Platelet Aggregation Inhibitors / therapeutic use*
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
Survival Rate / trends
Ticlopidine / analogs & derivatives,  therapeutic use
Time Factors
Treatment Outcome
Young Adult
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Enoxaparin; 0/Fibrinolytic Agents; 0/Immunoglobulin Fab Fragments; 0/Platelet Aggregation Inhibitors; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; A74586SNO7/clopidogrel; X85G7936GV/abciximab
Comment In:
J Am Coll Cardiol. 2010 Mar 2;55(9):865-6   [PMID:  20045277 ]

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