{"id":"ae410fd97ec8","type":"article","url":"https://hartvaat.nl/2024/03/12/rapid-nstemi-zeer-vroege-invasieve-strategie-bij-hoger-risico-nstemi/","title":"RAPID NSTEMI: zeer vroege invasieve strategie bij hoger risico NSTEMI","title_en":"Very early invasive strategy in higher risk non-ST-elevation acute coronary syndrome: the RAPID NSTEMI trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2023-323513","source_url":"https://doi.org/10.1136/heartjnl-2023-323513","authors":["Thomas A Kite","Andrew Ladwiniec","John P Greenwood","Chris P Gale","Brijesh Anantharam","Ranjit More","Simon Lee 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 P Banning","Anthony H Gershlick"],"significance":6,"published":"2024-03-12","source_date":"2024-03-12","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/nstemi-en-instabiele-angina/"],"congress":"","summary_en":"The RAPID NSTEMI trial tested a very early invasive strategy (within 2 hours) for higher-risk NSTEMI, finding that ultra-early intervention does not significantly improve outcomes over standard-timing invasive care.","created":"2026-07-03T10:30:49Z","updated":"2026-07-03T13:29:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De RAPID NSTEMI-trial onderzocht een zeer vroege invasieve strategie (<2 uur) bij hoger risico NSTEMI. Het primaire eindpunt werd niet significant bereikt, maar de vroege strategie was veilig en verminderde de verblijfsduur.","abstract_original":"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."}