Acute Coronary Syndrome Clinical Trial
Official title:
Early or Delayed Revascularization for Intermediate and High-risk Non ST-elevation Acute Coronary Syndromes?
Percutaneous coronary intervention (PCI) is the cornerstone of the care of intermediate and
high-risk non ST-elevation acute coronary syndromes (NSTE ACS). Revascularization reduces the
rate of cardiovascular death and recurrent myocardial infarction in this clinical setting.
The recommendation regarding the timing of intervention in this clinical setting is derived
from old trials and has a weak level of evidence. In fact, there are no conclusive randomized
trials in the contemporary era providing guidance on the optimal timing of intervention. In
addition, the optimal timing of this critical intervention has not been studied since the
development of new P2Y12-ADP receptor antagonists and the controversy surrounding the use of
pretreatment with a P2Y12-ADP receptor antagonist before intervention. Early intervention in
intermediate and high-risk non ST-elevation ACS is not well validated to date. In addition,
the recent changes in the use of pretreatment with P2Y12-ADP receptor antagonists may impact
on the potential benefit of an early intervention.
Based on these evidences, we hypothesize that with the current protocols of care without
pretreatment with a P2Y12-ADP receptor antagonist, an early PCI (<2 hours) would be superior
to a delayed (between 12 to 72 hours) PCI in the setting of intermediate or high-risk non-ST
elevation acute coronary syndrome to prevent cardiovascular death and ischemic recurrences.
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