V_alue of First Day Angiography/Angioplasty I_n Evolving N_on-ST Segment Elevation Myocardial Infarction: An O_pen Multicenter Randomized Trial. The VINO Study

Aims Direct angioplasty is an effective treatment for ST-elevation myocardial infarction. The role of very early angioplasty in non-ST-elevation infarction is not known. Thus, a randomized study of first day angiography/angioplasty vs early conservative therapy of evolving myocardial infarction without persistent ST-elevation was conducted. Methods One hundred and thirty-one patients with confirmed acute myocardial infarction without ST-segment elevations were randomized within 24h of last rest chest pain: 64 in the first day angiography/angioplasty group and 67 in the early conservative group (coronary angiography only after recurrent or stress induced myocardial ischaemia). Results All patients in the invasive group underwent coronary angiography on the day of admission (mean randomization–angiography time 6·2h). First day angioplasty of the infarct related artery was performed in 47% of the patients and bypass surgery in 35%. In the conservative group, 55% underwent coronary angiography, 10% angioplasty and 30% bypass surgery within 6 months. The primary end-point (death/reinfarction) at 6 months occurred in 6·2% vs 22·3% ( P <0·001). Six month mortality in the first day angiography/angioplasty group was 3·1% vs 13·4% in the conservative group ( P <0·03). Non-fatal reinfarction occurred in 3·1% vs 14·9% ( P <0·02). Conclusions First day coronary angiography followed by angioplasty whenever possible reduces mortality and reinfarction in evolving myocardial infarction without persistent ST-elevation, in comparison with an early conservative treatment strategy.