This small randomized trial (36) evaluated the outcomes of 201 patients with acute coronary syndromes ineligible for thrombolytic therapy. Patients were randomized to early triage angiography and subsequent therapies based on the angiogram vs conventional medical therapy consisting of aspirin, intravenous heparin, nitroglycerin, b-blockers, and analgesics. Sixty-four patients (58%) in the triage angiography group and 33 patients (37%) in the medical group received revascularization (p = 0.004). At hospital discharge, the primary end point of recurrent ischemic events or death occurred in 14 patients (13%) in the triage angiography vs 31 patients (34%) in the conservative group (45% risk reduction, 95% confidence interval [CI]: 27-59%, p = 0.0002). Long-term follow-up at a median of 21 mo revealed, however, no significant differences in the end points of late revascularization, recurrent MI or all-cause mortality (Fig. 5).
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