Conservative Non-Invasive Versus Routine Invasive Management in Coronary Artery Bypass Surgery Patients With Non ST Elevation Elevation Acute Coronary Syndrome (CABG-ACS)
Non ST Elevation Myocardial Infarction, Unstable Angina
About this trial
This is an interventional treatment trial for Non ST Elevation Myocardial Infarction focused on measuring Non-ST elevation myocardial infarction (NSTEMI), Non-ST elevation acute coronary syndrome (NSTE-ACS), Unstable Angina, Medical therapy, Coronary angiogram, Percutaneous coronary intervention, Coronary artery bypass surgery, Coronary revascularization, Health economics
Eligibility Criteria
Inclusion Criteria:
- Unstable angina or non-ST elevation myocardial infarction
- Stabilised symptoms without recurrent chest pain or IV therapy for 12 hrs when ambulant.
Exclusion Criteria:
- Refractory ischaemia (i.e. recurrent angina with minimal exertion or at rest (i.e. Canadian Cardiovascular Society class III or IV) not controlled by medical therapy)
- Cardiogenic shock
- Inability to give informed consent
- Unsuitable for invasive management.
Sites / Locations
- Royal Blackburn Hospital
- Royal Alexandra Hospital, Corsebar Road, Paislay
- Western Infirmary, Dumbarton Road
- Glasgow Royal Infirmary, 84 Castle St
- Golden Jubilee National Hospital, Clydebank, Dunbartonshire
Arms of the Study
Arm 1
Arm 2
No Intervention
Active Comparator
Conservative therapy
Invasive management
Conservative therapy group involves optimal medical therapy according to local hospital protocols with selective invasive management as clinically appropriate. Patients assigned to the conservative group may be referred for invasive management if the patient meets one of the following pre-specified criteria: Recurrent or refractory (class III or IV) angina with documented ischaemic ECG changes while on "optimal" medical therapy. New ST segment elevation in two contiguous leads without Q waves or T wave inversion greater than 3 mm or development of hemodynamic instability Deterioration in heart failure status (defined as Killip class 3 or 4).
Invasive management is timed as appropriate according to local NHS protocols. Usually, invasive management is expected to be performed in line with contemporary guidelines.