1
|
Lemesle G, Laine M, Pankert M, Puymirat E, Cuisset T, Boueri Z, Maillard L, Armero S, Cayla G, Bali L, Motreff P, Peyre JP, Paganelli F, Kerbaul F, Roch A, Michelet P, Baumstarck K, Bonello L. Early versus delayed invasive strategy for intermediate- and high-risk acute coronary syndromes managed without P2Y 12 receptor inhibitor pretreatment: Design and rationale of the EARLY randomized trial. Clin Cardiol 2018; 41:5-12. [PMID: 29356001 DOI: 10.1002/clc.22852] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 01/23/2023] Open
Abstract
According to recent literature, pretreatment with a P2Y12 ADP receptor antagonist before coronary angiography appears no longer suitable in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) due to an unfavorable risk-benefit ratio. Optimal delay of the invasive strategy in this specific context is unknown. We hypothesize that without P2Y12 ADP receptor antagonist pretreatment, a very early invasive strategy may be beneficial. The EARLY trial (Early or Delayed Revascularization for Intermediate- and High-Risk Non-ST-Segment Elevation Acute Coronary Syndromes?) is a prospective, multicenter, randomized, controlled, open-label, 2-parallel-group study that plans to enroll 740 patients. Patients are eligible if the diagnosis of intermediate- or high-risk NSTE-ACS is made and an invasive strategy intended. Patients are randomized in a 1:1 ratio. In the control group, a delayed strategy is adopted, with the coronary angiography taking place between 12 and 72 hours after randomization. In the experimental group, a very early invasive strategy is performed within 2 hours. A loading dose of a P2Y12 ADP receptor antagonist is given at the time of intervention in both groups. Recruitment began in September 2016 (n = 558 patients as of October 2017). The primary endpoint is the composite of cardiovascular death and recurrent ischemic events at 1 month. The EARLY trial aims to demonstrate the superiority of a very early invasive strategy compared with a delayed strategy in intermediate- and high-risk NSTE-ACS patients managed without P2Y12 ADP receptor antagonist pretreatment.
Collapse
Affiliation(s)
- Gilles Lemesle
- USIC et Centre Hémodynamique, Institut Cœur Poumon, Centre Hospitalier Régional et Universitaire de Lille; Faculté de Médecine de l'Université de Lille; Institut Pasteur de Lille, Unité INSERM UMR 1011; and FACT (French Alliance for Cardiovascular Trials), Lille, F-59000, France
| | - Marc Laine
- Aix-Marseille Université, AP-HM, Unité INSERM 1076, Unité de Soins Intensifs Cardiologiques, Department of Cardiology, Hôpital Nord, Marseille, France.,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France
| | - Mathieu Pankert
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France.,Department of Cardiology, Centre Hospitalier Henri Duffaut, Avignon, France
| | - Etienne Puymirat
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris, France; Université Paris Descartes, INSERM U-970, Paris, France
| | - Thomas Cuisset
- Aix-Marseille Université, AP-HM, Unité INSERM 1062, Unité de Soins Intensifs Cardiologiques, Department of Cardiology, Hôpital Nord, Marseille, France
| | - Ziad Boueri
- Department of Cardiology, Centre Hospitalier de Bastia, France
| | - Luc Maillard
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France.,Department of Cardiology, Clinique Axium, Aix-en-Provence, France
| | - Sébastien Armero
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France.,Department of Cardiology, Hôpital Européen, Marseille, France
| | - Guillaume Cayla
- Department of Cardiology, Centre Hospitalier Universitaire de Nîmes, Université de Montpellier, Nîmes, France
| | - Laurent Bali
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France.,Department of Cardiology, Centre Hospitalier de Cannes, France
| | - Pascal Motreff
- Department of Cardiology, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Jean-Pascal Peyre
- Department of Cardiology, Hôpital Privé Beauregard, Marseille, France
| | - Franck Paganelli
- Aix-Marseille Université, AP-HM, Unité INSERM 1076, Unité de Soins Intensifs Cardiologiques, Department of Cardiology, Hôpital Nord, Marseille, France
| | - François Kerbaul
- Pole RUSH, Assistance-Publique Hôpitaux de Marseille, Marseille, France
| | - Antoine Roch
- Emergency Department, Hôpital Nord, Marseille, France
| | | | - Karine Baumstarck
- Unité d'Aide Méthodologique à la Recherche Clinique, EA 3279, Laboratoire de Santé Publique, Aix-Marseille Université, Marseille, France
| | - Laurent Bonello
- Aix-Marseille Université, AP-HM, Unité INSERM 1076, Unité de Soins Intensifs Cardiologiques, Department of Cardiology, Hôpital Nord, Marseille, France.,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France
| |
Collapse
|