Document Detail

5-year outcomes in the FRISC-II randomised trial of an invasive versus a non-invasive strategy in non-ST-elevation acute coronary syndrome: a follow-up study.
MedLine Citation:
PMID:  16980115     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The FRISC-II invasive trial compared an early invasive with a non-invasive strategy in terms of death and myocardial infarction in non-ST-elevation acute coronary syndrome. We present 5-year follow-up results, overall and in subgroups based on recommended risk stratification criteria. METHODS: In the FRISC-II trial, 2457 patients with non-ST-elevation acute coronary syndrome were randomised to early invasive strategy (coronary angiography and, if appropriate, revascularisation, within 7 days from admission) or non-invasive primarily medical strategy. Risk stratification was done on the basis of risk indicators at randomisation: age older than 65 years, male sex, diabetes mellitus, previous myocardial infarction, ST-segment depression, raised troponin concentration (>0.03 mug/L), and raised C-reactive protein or interleukin 6. Information on events after 24 months was taken from national registries. Analyses were done on an intention-to-treat basis. FINDINGS: At 5 years the groups differed in terms of the primary composite endpoint of death, myocardial infarction, or both (invasive 217, 19.9 %; noninvasive 270, 24.5 %; risk ratio 0.81; 95% CI 0.69-0.95; p=0.009). 5-year mortality was 117 (9.7%) in the invasive group compared with 124 (10.1%) in the noninvasive group (0.95; 0.75 -1.21; p=0.693). Rates of myocardial infarction were 141 (12.9 %) in the invasive and 195 (17.7%) in the non-invasive group (0.73; 0.60-0.89; p=0.002). The benefit of the invasive strategy was confined to male patients, non-smokers, and patients with two or more risk indicators. INTERPRETATION: The 5-year outcome of this trial indicates sustained benefit of an early invasive strategy in patients with non-ST-elevation acute coronary syndrome at moderate to high risk.
Bo Lagerqvist; Steen Husted; Fredrik Kontny; Elisabeth Ståhle; Eva Swahn; Lars Wallentin;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Lancet     Volume:  368     ISSN:  1474-547X     ISO Abbreviation:  Lancet     Publication Date:  2006 Sep 
Date Detail:
Created Date:  2006-09-18     Completed Date:  2006-10-06     Revised Date:  2007-06-05    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  England    
Other Details:
Languages:  eng     Pagination:  998-1004     Citation Subset:  AIM; IM    
Department of Cardiology and Uppsala Clinical Research Center, University Hospital, S-751 85 Uppsala, Sweden.
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MeSH Terms
Aged, 80 and over
Coronary Angiography*
Dalteparin / administration & dosage*
Fibrinolytic Agents / administration & dosage*
Follow-Up Studies
Middle Aged
Myocardial Infarction / drug therapy,  mortality,  therapy
Myocardial Ischemia / drug therapy,  mortality,  therapy*
Myocardial Revascularization*
Prospective Studies
Risk Assessment
Risk Factors
Treatment Outcome
Reg. No./Substance:
0/Dalteparin; 0/Fibrinolytic Agents
Comment In:
Lancet. 2006 Sep 16;368(9540):966-9   [PMID:  16980093 ]
Nat Clin Pract Cardiovasc Med. 2007 May;4(5):246-7   [PMID:  17310229 ]

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