30 Oct 15-Year Study Shows Benefit of Early Surgical Treatment in Non-STEMI Coronary Syndrome
MedicalResearch.com Interview with:
Prof.Lars Wallentin
Prof. Lars Wallentin MD
Department of Medical Sciences, Cardiology
Uppsala Clinical Research Center
Uppsala University, Uppsala, Sweden
MedicalResearch.com: What is the background for this study?
Response: The FRISC2 study was performed 1996 – 1998 and reported 1999 for the first time a significant reduction in death and myocardial infarction by early invasive compared to non-invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). These pivotal results have been the basis for the current international treatment guidelines recommending an early invasive treatment strategy in patients with NSTE-ACS and elevated troponin and/or other indicators of a raised risk. Still there are remaining controversies concerning the long-term effects, the appropriate selection of patients for this approach and the opportunities for a more personalised approach to early invasive procedures.
MedicalResearch.com: What are the main findings?
Response: We performed a 15 years follow-up of the FRISC2 trial concerning the effects of an early invasive compared with a non-invasive strategy on all cardiovascular events, including not only first events but also repeated non-fatal events. This study showed, for the first time, that an early invasive compared with a non-invasive treatment strategy provided a lifelong postponement of the occurrence of death or the next MI by an average of 18 months and of death or the next rehospitalisation for ischemic heart disease by 37 months. The study also showed that the benefits were even larger in patients with elevated plasma level of troponin or the inflammation marker GDF-15.
MedicalResearch.com: What should readers take away from your report?
Response: As this study provided information on gains in survival time without new non-fatal events and as almost half the patients were deceased during follow-up, the study can be considered to provide a remaining lifetime perspective on the effects of an early invasive compared with a non-invasive treatment strategy in patients with NSTE-ACS. Even in such a remaining life-time perspective the results from the FRISC2 study support that an early invasive strategy should be the preferred regimen in the majority of patients with NSTE-ACS. The clarification of the remaining life-time consequences of an early invasive treatment strategy in NSTE-ACS are pioneering and have major interest to a broad spectrum of physicians as this one of the most common cardiac emergencies worldwide.”
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: For these purposes the present long-term study used a new methodology to estimate the difference in time to death or next non-fatal event between the randomized treatment strategies. This novel methodology seem to be a valuable tool for long-term evaluations of the effects of several other treatments.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Citation:
Early invasive versus non-invasive treatment in patients with non-ST-elevation acute coronary syndrome (FRISC-II): 15 year follow-up of a prospective, randomised, multicentre study Lars Wallentin, Lars Lindhagen, Elisabet Ärnström, Steen Husted, Magnus Janzon, Søren Paaske Johnsen, Frederic Kontny, Tibor Kempf, Lars-Åke Levin, Bertil Lindahl, Mats Stridsberg, Elisabeth Ståhle, Per Venge, Kai C Wollert, Eva Swahn, Bo Lagerqvist, for the FRISC-II study group
Lancet. 2016 Oct 15;388(10054):1903-1911. doi: 10.1016/S0140-6736(16)31276-4. Epub 2016 Aug 29.
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Last Updated on October 31, 2016 by Marie Benz MD FAAD