Invasive strategies in patients with acute coronary syndrome

This thesis covers several invasive strategies in non-ST-elevation acute coronary syndrome (NSTE-ACS) and in ST-elevation myocardial infarction (STEMI).
Part 1 of this thesis focused on timing of an invasive strategy in patients with NSTE-ACS. First, we analyzed the long term (5-year) clinical event rate in patients treated by percutaneous coronary intervention (PCI) either directly or 24-48 hours after initial coronary angiography (CAG). We found no significant difference in the composite endpoint of death or new MI at 5-year follow-up. However, myocardial infarction occurred significantly more often in patients treated in the direct PCI group. Secondly, we investigated the influence of a direct invasive strategy (<3 hours after admission) in comparison to an early strategy (12-24 hour). No difference in infarct size, measured by the area under the curve of creatine kinase-MB or high-sensitive troponinT, was found. In addition, no benefit in clinical endpoints or cardiac function could be demonstrated for a direct invasive strategy, but no disadvantage either. Thirdly, we investigated the timing to PCI in a real-world retrospective cohort analysis of non-ST-elevation myocardial infarction patients. We found no difference in mortality if PCI was performed within the first week of admission.
Part 2 of this thesis covers the question whether single culprit vessel or complete revascularization should be preferred in case of multivessel disease in stable coronary artery disease or NSTE-ACS. The major conclusion of this study is that we observed no significant difference between the groups in the occurrence of major adverse cardiac events or stent thrombosis during the follow-up period of 5-years. Secondly, we investigated the use of drug coated balloons (DCB) versus drug eluting stents in the invasive treatment of a highly selected group of STEMI patients. After 9 months follow-up, we found DCB’s to be an effective, safe and feasible strategy.