Topics:
Acute Coronary Syndromes (ACS)
Authors:
Lagerqvist, B.
Introduction
The FRISC-II invasive trial compared an early invasive versus a non-invasive strategy concerning death and myocardial infarction in non-ST-elevation acute coronary syndrome. This report presents the 5-year follow-up based information taken from national population registers in the Scandinavian countries.
FRISC-II
In the FRISC-II trial 2457 patients with non-ST-elevation acute coronary syndrome were randomised to an early invasive or a non-invasive strategy. Risk stratification was performed based on the following risk indicators at randomization: age>65, male gender, diabetes mellitus, previous myocardial infarction, ST-segment depression, troponin elevation (>0.03 ug/L) and elevation of C-reactive protein or Il-6.
At 5 years there was a difference in the primary composite of death and/or myocardial infarction 217 (19.9 %) in the invasive versus 270 (24.5 %) in the noninvasive group (RR 0.81; 95% CI 0.69 - 0.95; p=0.009). The 5-year mortality was 117 (9.7%) versus 124 (10.1%) (RR 0.95; CI 0.75 - 1.21; p=0.693) and the rate of myocardial infarction 141 (12.9 %) versus 195 (17.7 %) (RR 0.73; 95% CI 0.60 - 0.89; p=0.002) in the respective invasive and noninvasive groups.
The benefit of the invasive strategy was confined to males, non-smokers or the group with 2 or more risk indicators where the rate of death and myocardial infarction was 182 (21.2%) versus 240 (28.1%) (RR 0.75¸95% CI 0.64-0.89) and mortality 99 (10.5%) versus 112 (12.0%) (RR 0.87¸95% CI 0.68-1.13).
Introduction
The FRISC-II invasive trial compared an early invasive versus a non-invasive strategy concerning death and myocardial infarction in non-ST-elevation acute coronary syndrome. This report presents the 5-year follow-up based information taken from national population registers in the Scandinavian countries.
FRISC-II
In the FRISC-II trial 2457 patients with non-ST-elevation acute coronary syndrome were randomised to an early invasive or a non-invasive strategy. Risk stratification was performed based on the following risk indicators at randomization: age>65, male gender, diabetes mellitus, previous myocardial infarction, ST-segment depression, troponin elevation (>0.03 ug/L) and elevation of C-reactive protein or Il-6.
At 5 years there was a difference in the primary composite of death and/or myocardial infarction 217 (19.9 %) in the invasive versus 270 (24.5 %) in the noninvasive group (RR 0.81; 95% CI 0.69 - 0.95; p=0.009). The 5-year mortality was 117 (9.7%) versus 124 (10.1%) (RR 0.95; CI 0.75 - 1.21; p=0.693) and the rate of myocardial infarction 141 (12.9 %) versus 195 (17.7 %) (RR 0.73; 95% CI 0.60 - 0.89; p=0.002) in the respective invasive and noninvasive groups.
The benefit of the invasive strategy was confined to males, non-smokers or the group with 2 or more risk indicators where the rate of death and myocardial infarction was 182 (21.2%) versus 240 (28.1%) (RR 0.75¸95% CI 0.64-0.89) and mortality 99 (10.5%) versus 112 (12.0%) (RR 0.87¸95% CI 0.68-1.13).
Session Number : 708009
Session Title: Clinical Trial Update III
Conclusion
Conclusion
The 5 years outcome of the FRISC-2 trial indicates a sustained benefit of an early invasive strategy in moderate to high risk non-ST-elevation acute coronary syndrome.
Slide presentation [Available]
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author/s and is not necessarily the official position of the
European Society of Cardiology.