FRISC-II: Early Invasive CAD Treatment Postpones Death or MI in 15-Year Follow-Up

Larry Hand

October 18, 2016

UPPSALA, SWEDEN — Findings from 15-year follow-up of the Fast Revascularization During Instability in Coronary Artery Disease (FRISC-II) study provide "strong support" that early invasive treatment should be the preferred treatment strategy for patients with non–ST-elevation acute coronary syndrome compared with noninvasive treatment[1].

The FRISC-II trial, conducted in Sweden, Denmark, and Norway between 1996 and 1998, showed that early invasive treatment significantly reduced death and MI compared with noninvasive treatment in patients with non–ST-elevation CAD. In that trial patients were randomized to either revascularization with 7 days or noninvasive treatment.

Dr Lars Wallentin (Uppsala University, Sweden) and colleagues conducted a follow-up analysis of cardiovascular outcomes, with data available on 99% of the initially recruited 2457 patients involved in FRISC-II.

The results were published in the October 15, 2016 issue of the Lancet.

The researchers found that, during 15 years of follow-up, the invasive strategy postponed death of next MI by a mean of 549 days (95% CI 204–888, P=0.002).

"This effect was larger in nonsmokers (mean gain 809 days, 95% CI 402–1175; P=0.0182), patients with elevated troponin T (778 days, 95% CI 357–1165; P=0.0241), and patients with high concentrations of growth differentiation factor-15 (1356 days, 95% CI 507–1650; P=0.0210)," the researchers wrote.

The researchers also found that invasive therapy led to a mean of 1128 days' postponement of death or readmission to the hospital for ischemic heart disease (95% CI 830-1366).

"The study offers follow-up to 15 years, making it essentially a lifetime study. The benefit is largely in the first few years," Dr William S Weintraub (Christiana Care Health System, Newark, DE), author of an accompanying comment[2], told heartwire from Medscape.

Weintraub wrote in his commentary, "Substantial advances in care have been made since the time of the first FRISC-II study." A wait of 7 days for revascularization would be unusual today, he wrote.

"FRISC-II cannot be considered contemporary therapy," he told heartwire . "However, technical change and improved care over time is to be expected. Thus, long-term follow-up will often reflect standards of care from several years ago. Nonetheless, we have much to learn from long-term follow-up studies that we can incorporate with more contemporary data."

The Swedish Heart-Lung Foundation, the Swedish Foundation for Strategic Research, and the Uppsala Clinical Research Center funded this research. Wallentin reported receiving institutional research grants, consultancy fees, lecture fees, and travel support from Bristol-Myers Squibb, Pfizer, AstraZeneca, GlaxoSmithKline, and Boehringer Ingelheim, institutional research grants from Merck and Roche, consultancy fees from Abbott, and honoraria from GlaxoSmithKline. Disclosures for the coauthors are listed in the paper. Weintraub reports no relevant financial relationships.

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