Evidence map›Paper›PMID 38103913›Full record

Trial reportHeart (British Cardiac Society)2024

Very early invasive strategy in higher risk non-ST-elevation acute coronary syndrome: the RAPID NSTEMI trial.

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 and 10 more

Registry-linked trialAbstract readRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Heart (British Cardiac Society), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03707314 (A Randomised Controlled Trial of Very Early Angiography +/- Intervention Versus Standard of Care on Outcomes in Patients With Non ST-elevation Myocardial Infarction), which is not on this map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03707314 naterminatednot on this map

A Randomised Controlled Trial of Very Early Angiography +/- Intervention Versus Standard of Care on Outcomes in Patients With Non ST-elevation Myocardial Infarction

TypeinterventionalSponsorUniversity Hospitals, LeicesterRan2018 to 2021Enrolled425ConditionsCardiovascular, AttackArmsAngiography with follow-on revascularisation if indicated
3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Trial
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Thomas A KiteDepartment of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK tom.kite@nhs.net.ORCID 0000-0002-6021-5738
Andrew LadwiniecDepartment of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK.
John P GreenwoodLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds and the Department of Cardiology Leeds Teaching Hospitals NHS Trust, Leeds, UK.ORCID 0000-0002-2861-0914
Chris P GaleLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds and the Department of Cardiology Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Brijesh AnantharamPortsmouth Hospitals University NHS Trust, Portsmouth, UK.
Ranjit MoreBlackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.
Simon Lee HetheringtonDepartment of Cardiology, Kettering General Hospital NHS Foundation Trust, Kettering, UK.
Sohail Q KhanDepartment of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Peter O'KaneThe Royal Bournemouth Hospital, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK.
Roby RakhitDepartment of Cardiology, Royal Free Hospital and Institute of Cardiovascular Sciences, University College London, London, UK.
Alexander ChaseDepartment of Cardiology, Morriston Hospital, Swansea, UK.
Shaun BarberLeicester Clinical Trials Unit, University of Leicester, Leicester, UK.
Ghazala WaheedLeicester Clinical Trials Unit, University of Leicester, Leicester, UK.
Colin BerrySchool of Cardiovascular and Metabolic Health, British Heart Foundation Glasgow Cardiovascular Research Centre, Golden Jubilee National Hospital and University of Glasgow, Glasgow, UK.ORCID 0000-0002-4547-8636
Marcus FlatherNorwich Medical School, University of East Anglia, Norwich, UK.ORCID 0000-0001-5644-3116
Gerry P McCannDepartment of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK.ORCID 0000-0002-5542-8448
Nick CurzenFaculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.ORCID 0000-0001-9651-7829
Adrian P BanningDepartment of Cardiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Anthony H GershlickDepartment of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK.
RAPID NSTEMI Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo 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).

methodsMulticentre, 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.

resultsThe 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).

conclusionsA 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.

Indexed as

Acute Coronary SyndromeNon-ST Elevated Myocardial InfarctionPercutaneous Coronary InterventionCoronary AngiographyHumansPandemicsTreatment Outcomeacute coronary syndromepercutaneous coronary intervention

Identifiers

PMID38103913
PMCPMC10958296

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.