A PROSPECTIVE RANDOMIZED TRIAL OF TRIAGE ANGIOGRAPHY IN ACUTE CORONARY SYNDROMES INELIGIBLE FOR THROMBOLYTIC THERAPY - RESULTS OF THE MEDICINE VERSUS ANGIOGRAPHY IN THROMBOLYTIC EXCLUSION (MATE) TRIAL

Objectives. The purpose of this study was to determine if early triage angiography with revascularization, if indicated, favorably affects c linical outcomes in patients with suspected acute myocardial infarctio n who are ineligible for thrombolysis. Background. The majority of pat ients with acute myocardial infarction and other acute coronary syndro mes are considered ineligible for thrombolysis and therefore are not a fforded the opportunity for early reperfusion. Methods. This multicent er, prospective, randomized trial evaluated in a controlled fashion th e outcomes following triage angiography in acute coronary syndromes in eligible for thrombo lytic therapy. Eligible patients (n = 201) with < 24 h of symptoms were randomized to early triage angiography and subse quent therapies based on the angiogram versus conventional medical the rapy consisting of aspirin, intravenous heparin, nitroglycerin, beta-b lockers, and analgesics. Results. In the triage angiography group, 109 patients underwent early angiography and 64 (58%) received revascular ization, whereas in the conservative group, 54 (60%) subsequently unde r went nonprotocol angiography in response to recurrent ischemia and 3 3 (37%) received revascularization (p = 0.001). The mean time to revas cularization was 27 +/- 32 versus 88 +/- 98 h (p = 0.0001) and the pri mary endpoint of recurrent ischemic events or death occurred in 14 (13 %) versus 31 (34%) of the triage angiography and conservative groups, respectively (45% risk reduction, 95% CI 27-59%, p = 0.0002), There we re no differences between the groups with respect to initial hospital costs or length of stay. Long-term follow-up at a median of 21 months revealed no significant differences in the endpoints of late revascula rization, recurrent myocardial infarction, or all cause mortality. Con clusions. Early triage angiography in patients with acute coronary syn dromes who are not eligible for thrombolytics reduced the composite of recurrent ischemic events or death and shortened the time to definiti ve revascularization during the index hospitalization. Despite more fr equent early revascularization after triage angiography,,fe found no l ong term benefit in cardiac outcomes compared with conservative medica l therapy with revascularization prompted by recurrent ischemia. (J Am Cell Cardiol 1998;32:596-605) (C) 1998 by the American College of Car diology.