Very early invasive coronary angiography (ICA) does not improve clinical outcomes compared with ICA performed within 2–3 days in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), according to the results of the VERDICT trial presented at the 2018 ESC Congress. A total of 2,147 patients who were admitted to hospital in Copenhagen, Denmark, with suspected NSTE-ACS were randomly assigned to ICA performed very early or according to standard care (a median of 4.7 h or 61.6 h after randomization, respectively). During follow-up (median 4.3 years), the rate of the primary end point (a composite of all-cause death, nonfatal recurrent myocardial infarction, or hospital admission for refractory myocardial ischaemia or heart failure) was not significantly different between the two groups (27.5% versus 29.5%; HR 0.92, 95% CI 0.78–1.08). However, in patients at the highest risk (GRACE score > 140), very early ICA improved the primary end point (HR 0.81, 95% CI 0.67–1.01, P = 0.023).
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Kofoed, K. F. et al. Early versus standard care invasive examination and treatment of patients with non-ST-segment elevation acute coronary syndrome: the VERDICT (Very EaRly vs Deferred Invasive evaluation using Computerized Tomography) – randomized controlled trial. Circulation https://doi.org/10.1161/CIRCULATIONAHA.118.037152 (2018)
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Lim, G.B. Early invasive assessment of NSTE-ACS. Nat Rev Cardiol 15, 653 (2018). https://doi.org/10.1038/s41569-018-0084-y
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DOI: https://doi.org/10.1038/s41569-018-0084-y