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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

Peter A. McCullough, MD, MPH^*, William W. O’Neill, MD, FACC^*, Mariann Graham, BSN, Robert J. Stomel, DO, FACC, Felix Rogers, DO, FACC, Shukri David, MD, FACC^||, Ali Farhat, MD^*, Rasa Kazlauskaite, MD, Majid Al-Zagoum, MD^* and Cindy L. Grines, MD, FACC

^* Henry Ford Health System, Henry Ford Heart and Vascular Institute, Detroit, Michigan, USA
William Beaumont Hospital, Royal Oak, Michigan, USA
Botsford Hospital, Farmington Hills, Michigan, USA
Riverside Hospital, Trenton, Michigan, USA
^|| Providence Hospital, Southfield, Michigan, USA

View larger version (27K): [in a new window]   Figure 1 Flow diagram of 201 patients with acute coronary syndromes randomized to conservative care or early triage angiography. Protocol adherence was 98%, with 88 of 90 conservative group patients receiving medical care only and 109 of 111 triage group patients undergoing angiography within the first 24 h of hospital admission.

View larger version (44K): [in a new window]   Figure 2 Time from hospital admission to revascularization with either PTCA or CABG in 97 of 201 patients randomized to conservative care (striped columns; n = 33) or triage angiography (solid columns; n = 64) within 24 h of admission.

View larger version (35K): [in a new window]   Figure 3 Late events that occurred after hospital discharge in 201 patients randomized to triage angiography (solid columns; n = 111) or conservative care (striped columns; n = 90). Despite more early revascularization procedures during the hospitalization, there were no differences observed in long-term outcomes at a median of 21 months, including rehospitalization after discharge (Hosp.), coronary angiography during the follow-up period (Cath.), nonfatal myocardial infarction (MI) or death from any cause (Death).

View larger version (35K): [in a new window]   Figure 4 Cumulative revascularization and cardiac events in 201 patients randomized to triage angiography (solid columns; n = 111) or conservative care (striped columns; n = 90) over a median follow-up of 21 months. See definitions in the legend for Figure 3.

View larger version (13K): [in a new window]   Figure 5 Kaplan-Meier curves for freedom from recurrent myocardial infarction (MI) or death in 201 patients randomized to triage angiography (solid line; n = 111) or conservative care (broken line; n = 90) over a median follow-up of 21 months. The diamonds indicate censored patients. p = 0.8.