Very early invasive strategy in higher risk non-ST-elevation acute coronary syndrome: the RAPID NSTEMI trial Article Swipe
Thomas A Kite
,
Andrew Ladwiniec
,
John P. Greenwood
,
Chris P Gale
,
Brijesh Anantharam
,
Ranjit More
,
Simon Hetherington
,
Sohail Q. Khan
,
Peter O’Kane
,
Roby Rakhit
,
Alexander Chase
,
Shaun Barber
,
Ghazala Waheed
,
Colin Berry
,
Marcus Flather
,
Gerry P McCann
,
Nick Curzen
,
Adrian Banning
,
Anthony Gershlick
·
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1136/heartjnl-2023-323513
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1136/heartjnl-2023-323513
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. Trial registration number NCT03707314 .
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1136/heartjnl-2023-323513
- https://heart.bmj.com/content/heartjnl/early/2024/02/12/heartjnl-2023-323513.full.pdf
- OA Status
- hybrid
- Cited By
- 10
- References
- 24
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4389841719
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W4389841719Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1136/heartjnl-2023-323513Digital Object Identifier
- Title
-
Very early invasive strategy in higher risk non-ST-elevation acute coronary syndrome: the RAPID NSTEMI trialWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2023Year of publication
- Publication date
-
2023-12-16Full publication date if available
- Authors
-
Thomas A Kite, Andrew Ladwiniec, John P. Greenwood, Chris P Gale, Brijesh Anantharam, Ranjit More, Simon Hetherington, Sohail Q. Khan, Peter O’Kane, Roby Rakhit, Alexander Chase, Shaun Barber, Ghazala Waheed, Colin Berry, Marcus Flather, Gerry P McCann, Nick Curzen, Adrian Banning, Anthony GershlickList of authors in order
- Landing page
-
https://doi.org/10.1136/heartjnl-2023-323513Publisher landing page
- PDF URL
-
https://heart.bmj.com/content/heartjnl/early/2024/02/12/heartjnl-2023-323513.full.pdfDirect link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
hybridOpen access status per OpenAlex
- OA URL
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https://heart.bmj.com/content/heartjnl/early/2024/02/12/heartjnl-2023-323513.full.pdfDirect OA link when available
- Concepts
-
Medicine, Acute coronary syndrome, Myocardial infarction, Internal medicine, ST elevation, Randomized controlled trial, Incidence (geometry), Clinical trial, Surgery, Optics, PhysicsTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
10Total citation count in OpenAlex
- Citations by year (recent)
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2025: 9, 2024: 1Per-year citation counts (last 5 years)
- References (count)
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24Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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| cited_by_percentile_year.max | 99 |
| cited_by_percentile_year.min | 90 |
| countries_distinct_count | 2 |
| institutions_distinct_count | 19 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
| sustainable_development_goals[0].score | 0.8799999952316284 |
| sustainable_development_goals[0].display_name | Good health and well-being |
| citation_normalized_percentile.value | 0.91530368 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | True |