No bleeding benefit to very early invasive intervention in NSTE-ACS

Very early invasive coronary angiography (ICA) does not seem to decrease the risk of serious bleedings in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), reports a recent secondary analysis of the VERDICT trial.

The present study included 2,147 patients (mean age 63 years, 65 percent men) in whom the Thrombolysis in Myocardial Infarction and Bleeding Academic Research Consortium criteria was used to assess bleeding events occurring within 30 days of admission. Mortality was also set as an endpoint. Outcomes were compared between patients who received very early (<12 hours from diagnosis) or standard (48–72 hours from diagnosis) intervention.

Serious bleeding events were very rare, occurring in only 1.2 percent and 1.4 percent of patients in the very early and standard intervention groups, respectively, with the difference failing to reach significance (p=0.56). Of note, no fatal or serious bleeding events occurred before ICA in either group.

Multivariate Cox proportional hazards analysis confirmed that serious bleeding occurred at comparable rates between groups, suggesting that very early intervention does not statistically prevent the risk of serious bleeding (p=0.56).

Rather, significant risk factors for serious bleeds included the female sex (hazard ratio [HR], 2.7, 95 percent confidence interval [CI], 1.2–6.4; p=0.02), anaemia (HR, 7.0, 95 percent CI, 2.8–17.0; p<0.001), and increasing blood pressure (HR, 1.3, 95 percent CI, 1.1–1.5; p=0.01).