Very early invasive strategy in higher risk non-ST-elevation acute coronary syndrome: the RAPID NSTEMI trial
Very early invasive strategy in higher risk non-ST-elevation acute coronary syndrome: the RAPID NSTEMI trial
Objective To investigate whether a very early invasive strategy (IS)±revascularisation improves clinical outcomes compared with standard care IS in higher risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Methods Multicentre, randomised, controlled, pragmatic strategy trial of higher risk patients with NSTE-ACS, defined by Global Registry of Acute Coronary Events 2.0 score of ≥118, or ≥90 with at least one additional high-risk feature. Participants were randomly assigned to very early IS±revascularisation (<90 min from randomisation) or standard care IS±revascularisation (<72 hours). The primary outcome was a composite of all-cause mortality, new myocardial infarction or hospitalisation for heart failure at 12 months. results The trial was discontinued early by the funder due to slow recruitment during the COVID-19 pandemic. 425 patients were randomised, of whom 413 underwent an IS: 204 to very early IS (median time from randomisation: 1.5 hours (IQR: 0.9–2.0)) and 209 to standard care IS (median: 44.0 hours (IQR: 22.9–72.6)). At 12 months, there was no significant difference in the primary outcome between the early IS (5.9%) and standard IS (6.7%) groups (OR 0.93, 95% CI 0.42 to 2.09; p=0.86). The incidence of stroke and major bleeding was similar. The length of hospital stay was reduced with a very early IS (3.9 days (SD 6.5) vs 6.3 days (SD 7.6), p<0.01). Conclusions A strategy of very early IS did not improve clinical outcomes compared with a standard care IS in higher risk patients with NSTE-ACS. However, the primary outcome rate was low and the trial was underpowered to detect such a difference.
500-507
Kite, Thomas A.
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Ladwiniec, Andrew
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Greenwood, John P.
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Gale, Chris P.
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Anantharam, Brijesh
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More, Ranjit
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Hetherington, Simon Lee
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Khan, Sohail Q.
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O'Kane, Peter
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Rakhit, Roby
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Chase, Alexander
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Barber, Shaun
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Waheed, Ghazala
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Berry, Colin
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Flather, Marcus
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McCann, Gerry P.
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Curzen, Nick
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Banning, Adrian P.
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Gershlick, Anthony H.
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RAPID NSTEMI Investigators
12 March 2024
Kite, Thomas A.
de1adfeb-2c7b-4ddc-8a67-343caf9c5687
Ladwiniec, Andrew
df2609eb-f539-44f4-9385-38f4054a7ea6
Greenwood, John P.
8a764558-74f3-4639-aedd-fd775700fd6a
Gale, Chris P.
25773e5f-b91f-4b1d-8a3a-6f4efbf8268a
Anantharam, Brijesh
7896dc9a-9db5-4d40-8bd7-6e9d359bfadb
More, Ranjit
b5f92487-506c-4fe9-9670-238cac87fe52
Hetherington, Simon Lee
fe59122e-b32e-4121-b1fb-61a37677a33a
Khan, Sohail Q.
d5396e3f-56c2-4565-9873-890452b28eb5
O'Kane, Peter
be5ff4c8-eab3-4124-b414-39240125c08e
Rakhit, Roby
d5f7b8f0-9f99-44aa-9da6-4d3a42db7268
Chase, Alexander
a9822a81-15fa-4797-a24c-1494074b3dae
Barber, Shaun
242add66-b589-4427-8a6b-6fb458d4c723
Waheed, Ghazala
c6fd9895-db0e-4c01-8e8b-5559c4fc792b
Berry, Colin
dbbcf211-52a9-45de-95d6-87a52f78791b
Flather, Marcus
f1c158fe-9da3-4604-adfc-a5f8db10d5d3
McCann, Gerry P.
058e9548-9b74-48c0-a1e6-8d3cdb2f8369
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Banning, Adrian P.
63c9376f-08b6-4578-b036-4d6233545270
Gershlick, Anthony H.
5beb7f92-68f7-41df-ba72-ef3d2cdf20b9
Kite, Thomas A., Ladwiniec, Andrew, Greenwood, John P., Gale, Chris P., Anantharam, Brijesh, More, Ranjit, Hetherington, Simon Lee, Khan, Sohail Q., O'Kane, Peter, Rakhit, Roby, Chase, Alexander, Barber, Shaun, Waheed, Ghazala, Berry, Colin, Flather, Marcus, McCann, Gerry P., Curzen, Nick, Banning, Adrian P. and Gershlick, Anthony H.
,
RAPID NSTEMI Investigators
(2024)
Very early invasive strategy in higher risk non-ST-elevation acute coronary syndrome: the RAPID NSTEMI trial.
Heart, 110 (7), .
(doi:10.1136/heartjnl-2023-323513).
Abstract
Objective To investigate whether a very early invasive strategy (IS)±revascularisation improves clinical outcomes compared with standard care IS in higher risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Methods Multicentre, randomised, controlled, pragmatic strategy trial of higher risk patients with NSTE-ACS, defined by Global Registry of Acute Coronary Events 2.0 score of ≥118, or ≥90 with at least one additional high-risk feature. Participants were randomly assigned to very early IS±revascularisation (<90 min from randomisation) or standard care IS±revascularisation (<72 hours). The primary outcome was a composite of all-cause mortality, new myocardial infarction or hospitalisation for heart failure at 12 months. results The trial was discontinued early by the funder due to slow recruitment during the COVID-19 pandemic. 425 patients were randomised, of whom 413 underwent an IS: 204 to very early IS (median time from randomisation: 1.5 hours (IQR: 0.9–2.0)) and 209 to standard care IS (median: 44.0 hours (IQR: 22.9–72.6)). At 12 months, there was no significant difference in the primary outcome between the early IS (5.9%) and standard IS (6.7%) groups (OR 0.93, 95% CI 0.42 to 2.09; p=0.86). The incidence of stroke and major bleeding was similar. The length of hospital stay was reduced with a very early IS (3.9 days (SD 6.5) vs 6.3 days (SD 7.6), p<0.01). Conclusions A strategy of very early IS did not improve clinical outcomes compared with a standard care IS in higher risk patients with NSTE-ACS. However, the primary outcome rate was low and the trial was underpowered to detect such a difference.
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RAPID NSTEMI Manuscript_final revised
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Accepted/In Press date: 27 November 2023
e-pub ahead of print date: 16 December 2023
Published date: 12 March 2024
Additional Information:
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.
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Local EPrints ID: 492045
URI: http://eprints.soton.ac.uk/id/eprint/492045
ISSN: 1355-6037
PURE UUID: 3acefe2c-d46a-4906-9ad6-f566c1562c25
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Date deposited: 15 Jul 2024 16:34
Last modified: 20 Jul 2024 01:40
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Contributors
Author:
Thomas A. Kite
Author:
Andrew Ladwiniec
Author:
John P. Greenwood
Author:
Chris P. Gale
Author:
Brijesh Anantharam
Author:
Ranjit More
Author:
Simon Lee Hetherington
Author:
Sohail Q. Khan
Author:
Peter O'Kane
Author:
Roby Rakhit
Author:
Alexander Chase
Author:
Shaun Barber
Author:
Ghazala Waheed
Author:
Colin Berry
Author:
Marcus Flather
Author:
Gerry P. McCann
Author:
Adrian P. Banning
Author:
Anthony H. Gershlick
Corporate Author: RAPID NSTEMI Investigators
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