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OPTIMA: Op timal Tim ing of PCI in Unstable A ngina

OPTIMA: Op timal Tim ing of PCI in Unstable A ngina. Prospective, Randomized Evaluation of Immediate Versus Deferred Angioplasty in Patients with High Risk Acute Coronary Syndromes. Current controlled trial number: ISRCTN80874637.

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OPTIMA: Op timal Tim ing of PCI in Unstable A ngina

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  1. OPTIMA:Optimal Timing of PCI in Unstable Angina Prospective, Randomized Evaluation of Immediate Versus Deferred Angioplasty in Patients with High Risk Acute Coronary Syndromes Current controlled trial number: ISRCTN80874637 RK Riezebos1, E Ronner1, E Ter Bals1, T Slagboom1, F Kiemeneij1, G Amoroso1, MS Patterson1, JG Tijssen2, MJ Suttorp3, GJ Laarman1 1Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands 2Amsterdam Medical Center, Amsterdam, The Netherlands 3St Antonius Hospital, Nieuwegein, The Netherlands

  2. Introduction • Current guidelines recommend an early invasive strategy in high risk NSTE-ACS • The precise timing of early PCI is controversial. • Immediate PCI may prevent (spontaneous) cardiac events • Deferred PCI may lead to less peri-procedural complications

  3. OPTIMA trial • Optimal timing of PCI in unstable angina • To compare immediate with 24–48 hours deferred PCI in the early invasive management of NSTE-ACS • Hypothesis: In high risk NSTE-ACS immediate PCI reduces cardiac events

  4. Patients • Patientswith high risk NSTE-ACS • No indicationfor urgent PCI • Immediatecoronaryangiography • Culpritlesionamenablefor PCI

  5. Randomized treatments • Randomization in cathlab after angiography • Immediate PCI • PCI of culprit lesion in same session • Deferred PCI • PCI of culprit lesion after repeat angiography 24-48 hours later • Triple antiplatelet therapy • Abciximab, clopidogrel and aspirin

  6. Flowchart

  7. Time from randomization to PCI

  8. Clinical events at 30 days

  9. Primary endpoint at 30 days

  10. Infarct size during initial hospitalization peak CKMB: P<0.01 % CKMB (median): 9.8 4.9 (ng/L)

  11. Conclusions • Immediate PCI increased the rate of periprocedural MI compared to a cooling down strategy of deferred PCI • The results of the study suggest that there is no need to rush to PCI in non-refractory high risk NSTE-ACS patients

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