IMPACT OF EARLY INVASIVE VERSUS SELECTIVE INVASIVE MANAGEMENT ON CLINICAL OUTCOMES IN HIGH-RISK PATIENTS WITH NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROME TOMOGRAPHY

Abstract

Background: Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is associated with a considerable risk of recurrent ischemia, myocardial infarction, and mortality. The optimal use and timing of invasive management in high-risk patients remain important clinical considerations. Objective: To compare the clinical outcomes of early invasive versus selective invasive management in high-risk patients with NSTE-ACS. Methods: This randomized comparative study was conducted at the Department of Cardiology, Allama Iqbal Memorial Teaching Hospital,  Sialkot from April 2022 to March 2023. A total of 135 high-risk patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) were included and allocated into two management groups: 68 patients underwent an early invasive strategy (Group A), while 67 patients received a selective invasive strategy (Group B). The sample size and group distribution were based on the ICTUS randomized trial, which enrolled the same number of patients for comparison of these two treatment approaches. Results: A total of 135 patients with high-risk non-ST-segment elevation acute coronary syndrome (NSTE-ACS) were included, with 68 allocated to the early invasive group and 67 to the selective invasive group. Baseline characteristics were comparable between groups, including age ≥65 years (44.1% vs. 44.8%), male gender (73.5% vs. 73.1%), previous myocardial infarction (25.0% vs. 20.9%), and previous PCI (13.2% vs. 10.4%). Coronary angiography during initial hospitalization was significantly more frequent in the early invasive group (98.5% vs. 53.7%; p<0.001), as was angiography within one year (98.5% vs. 67.2%; p<0.001). Revascularization rates were also higher in the early invasive group at one year (79.4% vs. 53.7%; p=0.002) and ten years (82.4% vs. 61.2%; p=0.008). Conclusion: It is concluded that early invasive management substantially increased the use of coronary angiography and revascularization but did not significantly reduce long-term mortality or spontaneous myocardial infarction compared with selective invasive management.