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Angiography

Immediate Coronary Angiography Not Beneficial in Acute Coronary Syndrome with Heart Failure

Strategic Insights

— 2 min read

A new study conducted in South Korea suggests that immediate coronary angiography may not provide a clinical benefit for patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) complicated by acute decompensated heart failure (ADHF). The EARLY-HF trial, which was prematurely terminated due to COVID-19-related constraints, found that patients who received immediate coronary angiography within 2 hours of randomization did not have a significantly different outcome compared to those who received delayed coronary angiography. The study, published in the journal Cardiovascular Revascularization Medicine, highlights the importance of carefully considering the timing of coronary angiography in patients with NSTE-ACS and ADHF.

Key Takeaways:

  • The EARLY-HF trial was conducted to evaluate the optimal timing of coronary angiography in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) complicated by acute decompensated heart failure (ADHF).
  • 85 patients were randomly divided into two groups: immediate CAG within 2 hours of randomization and delayed CAG following stabilization of heart failure.
  • The primary outcome was the composite of 12-month all-cause mortality, non-fatal myocardial infarction (MI), and recurrent ischemia.
  • The incidence of the primary outcome was 35.6% vs. 24.2% in the two groups, respectively, but the difference was not statistically significant (P = 0.240).
  • No statistically significant differences were observed in the individual components of the primary outcome at 1 month, 12 months, or during hospitalization except for a higher 12-month cardiovascular mortality rate in the immediate CAG group.
  • The study concluded that immediate CAG within 2 hours of randomization did not demonstrate a clinical benefit over delayed CAG in this trial.
  • Major contributors to the study included Seongho Park from the Department of Cardiovascular Medicine, Mokpo Hankook Hospital, Mokpo, South Korea, and several other authors from various institutions.

Statistics:

  • 85 patients were enrolled in the EARLY-HF trial.
  • 43 patients were randomly divided into the immediate CAG group, while 42 patients were divided into the delayed CAG group.
  • The incidence of the primary outcome was 35.6% in the immediate CAG group vs. 24.2% in the delayed CAG group.
  • The composite primary outcome included all-cause mortality, non-fatal myocardial infarction (MI), and recurrent ischemia.
  • A total of 67.4% and 69.1% of patients in the immediate and delayed CAG groups, respectively, underwent revascularization.

Sources:

  • NewsRx. Findings from Department of Cardiovascular Medicine in the Area of Acute Coronary Syndrome Described (Immediate versus delayed coronary angiography in patients with non-ST segment elevation acute coronary syndrome complicated with acute ...). Heart Disease Weekly. October 26, 2025; p 538.
  • Cardiovascular Revascularization Medicine. Immediate versus delayed coronary angiography in patients with non-ST segment elevation acute coronary syndrome complicated with acute decompensated heart failure: The EARLY-HF randomized clinical trial. Elsevier.

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