Does Early Angiography Benefit Thrombolytic-Ineligible Patients?

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Does Early Angiography Benefit Thrombolytic-Ineligible Patients?

The benefit of angiography is unclear in patients with suspected AMI who are ineligible for thrombolytic therapy. This study examined whether early angiography reduces recurrent ischemic events and death rates in such patients. Researchers randomized patients to two groups. Of 111 patients in the early angiography group, 109 received an angiogram as quickly as possible (mean, 16 hours). All 90 patients in the conservative arm were admitted; 54 had angiograms for persistent pain despite medical therapy, recurrent pain with ECG changes, or hemodynamic instability. All received aspirin, heparin, nitroglycerine, and beta-blockers.

Both groups had the same rates of inhospital death and recurrent MI (3%). The rate of the inhospital composite endpoint (recurrent ischemic events or death) was 13% in the early angiography group versus 34% in the conservative group (p=0.0002). Rates of long-term (median, 21 months) composite outcomes, length of stay, and mean cost of stay did not differ significantly.

Comment: This study showed no benefit in clinical outcomes but had little power to detect a difference. The short-term difference in ischemic rates is due to the protocol itself. Patients in the conservative arm who received angiogram for chest pain were categorized as having recurrent ischemia. More patients in the early angiography group went home early or received prompt intervention, but the significance of these interim variables is unclear.

— JM Christensen

Published in Journal Watch Emergency Medicine December 1, 1998

Citation(s):

McCullough PA et al. A prospective randomized trial of triage angiography in acute coronary syndromes ineligible for thrombolytic therapy: Results of the Medicine versus Angiography in Thrombolytic Exclusion (MATE) trial. J Am Coll Cardiol 1998 Sep 32 596-605.

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