Abstract 4510: Long-term Clinical Outcomes of an Early Invasive Strategy Compared With a Conservative Strategy for Non-ST-Elevation Acute Coronary Syndromes: A Collaborative Analysis of Individual Patient Data From the FRISC-II, ICTUS, RITA-3 Trials

Background: Current guidelines for patients with high-risk Non-ST-Elevation Acute Coronary Syndromes (NSTE-ACS) recommend an early invasive strategy. The FRISC II, ICTUS, and RITA-3 trials compared this strategy with a conservative strategy, with variable long-term outcomes. We present the pooled 5-year outcomes on cardiovascular death or MI. Methods: We pooled individual patient data of 5467 patients presenting with NSTE-ACS, randomized to an early invasive strategy, consisting of early routine catheterization and subsequent revascularization if appropriate, or a selective invasive strategy, consisting of ischemia guided catheterization. The main composite endpoint was cardiovascular death or MI at 5 years after randomization. Cumulative event rates were obtained with the Kaplan-Meier method. Hazard ratios were obtained with Cox proportional hazards models. Risk stratification was performed based on baseline-risk according to the GRACE risk score. Results: The 3 trials provided data on 5467 patients. At 5 years, the cumulative event rate of cardiovascular death or MI was 14.8% in the early invasive strategy and 17.8% in the conservative strategy (HR 0.82, 95% CI: 0.71– 0.93, Conclusion: In patients with high-risk NSTE-ACS, a long-term benefit of an early invasive strategy was observed in risk of cardiovascular death or spontaneous MI.