Fast Assessment and Speedy Treatment of NSTEMI (FAST-NSTEMI)

Purpose: In a registry-based randomized clinical trial (R-RCT), we aim to determine if immediate invasive strategy with coronary angiography and percutaneous coronary intervention within 4 hours of hospital arrival improve outcomes in patients with non-ST-elevation myocardial infarction (NSTEMI) as compared with late invasive strategy according to current standard of care.State of knowledge: In NSTEMI patients, early, within the first week, revascularization improves outcomes and reduces mortality and re-infarction as compared with non-invasive strategy.

In patients with ST-elevation myocardial infarction, optimal results are obtained by immediate coronary revascularization. For patients with NSTEMI, the optimal timing of revascularization is unknown.

However, small RCTs indicate that invasive strategy within 24 hours might improve outcomes, especially in high-risk patients.Project organization, method: The project will be conducted in Sweden and Europe in collaboration with SWEDEHEART and EuroHeart.

The study will be led by Swedish investigators and coordinated by UCR in Sweden, which has a track record of coordinating R-RCTs. We aim to start trial planning in Q4 2024 and include the first patient in Q1 2026.

During planning, the goal is to form a study team, finalize protocols and study procedures, identify national coordinators, participating centers, prepare applications to regulatory authorities, design the eCRF and data capture systems, and secure funding for the study.