NSTE-ACS: Early vs Selective Strategy for Reducing Spontaneous MI

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A selective invasive strategy may be appropriate for some patients with NSTE-ACS.
A selective invasive strategy may be appropriate for some patients with NSTE-ACS.

HealthDay News — An early invasive strategy has no benefit for reducing the 10-year composite outcomes of death or spontaneous myocardial infarction (MI) for patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and elevated cardiac troponin T, according to a study published in the Journal of the American College of Cardiology.

Niels P.G. Hoedemaker, MD, from the University of Amsterdam, and colleagues examined the 10-year clinical outcomes of an early invasive versus a selective invasive strategy in 1,200 patients with NSTE-ACS and elevated cardiac troponin T.

The researchers observed no significant between-group difference in 10-year death or spontaneous MI (33.8% and 29% for early invasive and selective invasive, respectively; hazard ratio [HR]: 1.12; 95% CI, 0.97-1.46; P =.11). Revascularization occurred in 82.6% and 60.5% of the early and selective invasive groups, respectively. Additional outcomes did not differ between the groups, except for the rate of death or MI, which was higher in the early versus the selective invasive group (37.6% vs 30.5%; HR: 1.30; 95% CI, 1.07-1.58; P =.009); this was driven by an elevated rate of procedure-linked MI in the early invasive group (6.5% vs 2.4%; HR: 2.82; 95% CI, 1.53-5.20; P =.001).

"We believe that a selective invasive strategy may be a viable option in selected patients," the authors write.

One author disclosed financial ties to AstraZeneca. The study was funded by educational grants from several pharmaceutical companies. Roche Diagnostics provided the reagents for core laboratory cardiac troponin T measurements.


  1. Hodemaker NPG, Damman P, Woudstra P, et al. Early invasive vs selective strategy for non-ST-segment elevation acute coronary syndrome. J Am Coll Cardiol. 2017;69(15):1883-1893. doi: 10.1016/j.jacc.2017.02.023
  2. Bavry AA. Non-ST-segment elevation acute coronary syndromes. J Am Coll Cardiol. 2017;69(15). doi: 10.1016/j.jacc.2017.02.021
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