V_alue of First Day Angiography/Angioplasty I_n Evolving N_on-ST Segment Elevation Myocardial Infarction: An O_pen Multicenter Randomized Trial. The VINO Study

Spacek, R; Widimský, Petr; Straka, Z.; Jirešová, Eva; Dvoŕák, J; Polášek, Rostislav; Karel, I; Radovan, Jirmar; Lisa, Libor; Buděšínský, Tomáš; Málek, Filip; Stanka, P

doi:10.1053/euhj.2001.2735

Cited by 148 publications

(5 citation statements)

References 46 publications

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“…We searched and analyzed those articles addressing the treatment strategies for NSTE-ACS. Furthermore, we studied the details of the related studies according to the 2012 guidelines (19); these studies include well-known studies such as the FRISC II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease II) (4), the RITA 3 (Randomized Intervention Trial of Unstable Angina 3) trial (8), TACTICS-TIMI 18 (Treat angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction 18) trial (7), ICTUS (Invasive vs Conservative Treatment in Unstable Coronary Syndromes) trial (29), TIMI IIIB (Thrombolysis in Myocardial Infarction IIIB) (30), MATE (Medicine vs Angiography in Thrombolytic Exclusion) (31), and VINO (Value of First Day Angiography/Angioplasty In Evolving Non-ST Segment Elevation Myocardial Infarction) (32). Based on the above mentioned studies, we found that an invasive strategy could improve the short- or long-term survival rates of NSTE-ACS patients compared to a conservative strategy.…”

Section: Discussionmentioning

confidence: 99%

Outcomes in patients with non-ST-elevation acute coronary syndrome randomly assigned to invasive versus conservative treatment strategies: A meta-analysis

Li¹,

Liu²,

Lu³

2014

Clinics

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OBJECTIVE:The goal of the present study was to compare the prognoses of patients with non-ST-elevation acute coronary syndromes who were treated with invasive or conservative treatment strategies.METHODS:We performed a meta-analysis of studies of patients with non-ST-elevation acute coronary syndromes to assess the benefits of an invasive strategy vs. a conservative strategy for short- and long-term survival. We searched PubMed for studies published from 1990 to November 2012 that investigated the effects of an invasive vs. conservative strategy in patients with non-ST-elevation acute coronary syndromes. The following search terms were used: “non-ST-elevation myocardial infarction”, “unstable angina”, “acute coronary syndromes”, “invasive strategy”, and “conservative strategy”. The primary endpoints were all-cause mortality at 30 days and 1 year.RESULTS:Seven published studies were included in the present meta-analysis. The pooled analyses show that an invasive strategy decreased the risk of death (risk ratio [0.839] [95% confidence interval {0.648-1.086}; I2, 86.46%] compared to a conservative strategy over a 30-day-period. Furthermore, invasive treatment also decreased patient mortality (risk ratio [0.276] [95% confidence interval {0.259-0.294}; I2, 94.58%]) compared to a conservative strategy for one year.CONCLUSION:In non-ST-elevation acute coronary syndromes, an invasive strategy is comparable to a conservative strategy for decreasing short- and long-term mortality rates.

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Section: Discussionmentioning

confidence: 99%

Outcomes in patients with non-ST-elevation acute coronary syndrome randomly assigned to invasive versus conservative treatment strategies: A meta-analysis

Li¹,

Liu²,

Lu³

2014

Clinics

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“…The first was that prior investigations comparing invasive to selectively invasive strategies did not control for noninvasive testing as they either did not perform noninvasive testing before discharge, [13][14][15][16] used less accurate modalities (eg, ECG-based stress testing), or deployed a nonstandardized imaging approach. 4,[17][18][19][20] These variances could account for the reported small increase in adverse cardiac outcomes and cardiac readmissions in some studies. 13,17,21 The second was based on this team's prior work demonstrating Nonischemic (negative) and ischemic (positive) cases in the cardiac magnetic resonance (CMR) arm depicting wall motion, rest and stress perfusion, T2 mapping, and late gadolinium enhancement.…”

Section: Discussionmentioning

confidence: 99%

“…The first was that prior investigations comparing invasive to selectively invasive strategies did not control for noninvasive testing as they either did not perform noninvasive testing before discharge, 13–16 used less accurate modalities (eg, ECG-based stress testing), or deployed a nonstandardized imaging approach. 4,17–20 These variances could account for the reported small increase in adverse cardiac outcomes and cardiac readmissions in some studies. 13,17,21 The second was based on this team’s prior work demonstrating that CMR-based strategies in emergency department patients with acute chest pain without elevated serum troponin that were managed in emergency department observation units reduced revascularization events and reduced healthcare utilization relative to patients managed on Cardiology inpatient services.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Magnetic Resonance Imaging Versus Invasive-Based Strategies in Patients With Chest Pain and Detectable to Mildly Elevated Serum Troponin: A Randomized Clinical Trial

Miller

Mahler

Snavely

et al. 2023

Circ: Cardiovascular Imaging

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Background: The optimal diagnostic strategy for patients with chest pain and detectable to mildly elevated serum troponin is not known. The objective was to compare clinical outcomes among an early decision for a noninvasive versus an invasive-based care pathway. Methods: The CMR-IMPACT trial (Cardiac Magnetic Resonance Imaging Strategy for the Management of Patients with Acute Chest Pain and Detectable to Elevated Troponin) was conducted at 4 United States tertiary care hospitals from September 2013 to July 2018. A convenience sample of 312 participants with acute chest pain symptoms and a contemporary troponin between detectable and 1.0 ng/mL were randomized early in their care to 1 of 2 care pathways: invasive-based (n=156) or cardiac magnetic resonance (CMR)–based (n=156) with modification allowed as the patient condition evolved. The primary outcome was a composite including death, myocardial infarction, and cardiac-related hospital readmission or emergency visits. Results: Participants (N=312, mean age, 60.6 years, SD 11.3; 125 women [59.9%]), were followed over a median of 2.6 years (95% CI, 2.4–2.9). Early assigned testing was initiated in 102 out of 156 (65.3%) CMR-based and 110 out of 156 (70.5%) invasive-based participants. The primary outcome (CMR-based versus invasive-based) occurred in 59% versus 52% (hazard ratio, 1.17 [95% CI, 0.86–1.57]), acute coronary syndrome after discharge 23% versus 22% (hazard ratio, 1.07 [95% CI, 0.67–1.71]), and invasive angiography at any time 52% versus 74% (hazard ratio, 0.66 [95% CI, 0.49–0.87]). Among patients completing CMR imaging, 55 out of 95 (58%) were safely identified for discharge based on a negative CMR and did not have angiography or revascularization within 90 days. Therapeutic yield of angiography was higher in the CMR-based arm (52 interventions in 81 angiographies [64.2%] versus 46 interventions in 115 angiographies [40.0%] in the invasive-based arm [ P =0.001]). Conclusions: Initial management with CMR or invasive-based care pathways resulted in no detectable difference in clinical and safety event rates. The CMR-based pathway facilitated safe discharge, enriched the therapeutic yield of angiography, and reduced invasive angiography utilization over long-term follow-up. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01931852.

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“…Average follow-up period of European and US/international trials was 43 months and 18.4 months, respectively. Baseline characteristics of European and the US/international trials are mentioned in Table 1 [ 4 - 20 ]. Similarly, outcome characteristics of European and US/international trials are summarized in Table 2 [ 4 - 20 ].…”

Section: Resultsmentioning

confidence: 99%

The Effects of Geography on Outcomes of Routine Early Versus Selective Late Revascularization Strategy in the Treatment of Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Transatlantic Randomized Controlled Trials

Virk

Krittanawong

et al. 2018

J Clin Med Res

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BackgroundThe optimal timing of revascularization in unstable angina (UA) or non-ST-segment elevation myocardial infarction (NSTEMI) remains uncertain. We compared routine early revascularization (REV) versus selective late revascularization (SLR) strategies and divergence in the approach of cardiologists in the United States and Europe.MethodsSeventeen randomized controlled trials (RCTs) (15,812 patients) were extracted from PubMed, Cochrane Library, EMBASE and Web of Science databases. The data were pooled using the Der Simonian and Laird random-effect models and expressed as pooled risk ratios (RR) with 95% confidence intervals (95% CIs).ResultsOverall, there was no difference in all-cause mortality (RR: 1.01, 95% CI: 0.95 - 1.08, P = 0.7), myocardial infarction (MI) (RR: 0.98, 95% CI: 0.79 - 1.22, P = 0.85) or coronary artery bypass grafting (CABG) (RR: 1.33, 95% CI: 0.92 - 1.91, P = 0.12) between REV and SLR strategy. There were trends of decreased incidence of MI in REV, 13.3% (1,029/7,704) vs. 15.1% (1,108/7,314) in SLR (P = 0.007), and rate of CABG was higher in REV, 4.9% (140/2,831) vs. 3.7% (105/2,819) in SLR (P = 0.031). There were trends of lower all-cause mortality in the combined US/international trials in both REV 8.4% (390/4,624) vs. 22.8% (908/3,975) (P < 0.001) and SLR 8% (359/4,421) vs. 24% (910/3,808) (P < 0.001) compared to the European trials. There were also trends of lower rates of MI in the European trials in the REV group 20% (623/3,080) vs. 25% (712/2,893) in SLR (P = 0.001) and higher rates of CABG in REV 8.3% (96/1,144) vs. 5.7% (67/1,165) in SLR (P = 0.02); however, there were no significant effects in the pooled RR ratios even after subgroup analysis between US/international trials and European trials.ConclusionsDespite having contemporary differences in the management approach towards UA/NSTEMI patients, no significant differences in trends were observed with REV strategy in US/international trials vs. European trials.

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V_alue of First Day Angiography/Angioplasty I_n Evolving N_on-ST Segment Elevation Myocardial Infarction: An O_pen Multicenter Randomized Trial. The VINO Study

Abstract: First day coronary angiography followed by angioplasty whenever possible reduces mortality and reinfarction in evolving myocardial infarction without persistent ST-elevation, in comparison with an early conservative treatment strategy.

Cited by 148 publications

References 46 publications

Outcomes in patients with non-ST-elevation acute coronary syndrome randomly assigned to invasive versus conservative treatment strategies: A meta-analysis

Outcomes in patients with non-ST-elevation acute coronary syndrome randomly assigned to invasive versus conservative treatment strategies: A meta-analysis

Cardiac Magnetic Resonance Imaging Versus Invasive-Based Strategies in Patients With Chest Pain and Detectable to Mildly Elevated Serum Troponin: A Randomized Clinical Trial

The Effects of Geography on Outcomes of Routine Early Versus Selective Late Revascularization Strategy in the Treatment of Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Transatlantic Randomized Controlled Trials

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