When to do coronary angiography for NSTEMI with acute heart failure
Trial of IMmediate Invasive Versus Delayed Coronary ANGiography in Non-ST-Segment Elevation Myocardial Infarction Complicated by Acute Decompensated Heart Failure: The TIMING-AHF Trial
This trial will test whether doing coronary angiography immediately (within 2 hours) versus delaying it after stabilization reduces deaths, heart attacks, or heart-failure hospitalizations over 12 months in adults with NSTEMI complicated by acute decompensated heart failure.
Quick facts
| Phase | Not applicable |
|---|---|
| Study type | Interventional |
| Enrollment | 780 (estimated) |
| Ages | 19 Years and up |
| Sex | All |
| Sponsor | Chonnam National University Hospital Academic / other |
| Locations | 20 sites (Changwon and 19 other locations) |
| Trial ID | NCT07002164 on ClinicalTrials.gov |
What this trial studies
This randomized interventional trial assigns adults with NSTEMI and acute decompensated heart failure to either immediate coronary angiography (within 2 hours of diagnosis) or delayed angiography after clinical stabilization. The primary endpoint is a composite of all-cause death, non-fatal myocardial infarction, or hospitalization for heart failure at 12 months. Key exclusion criteria include cardiogenic shock at presentation, ST-elevation MI, recent or planned CABG, life-threatening arrhythmias, non-ischemic causes of heart failure, pregnancy, and life expectancy under one year. The trial is led by Chonnam National University Hospital and enrolls patients at multiple tertiary centers in South Korea.
Who should consider this trial
Good fit: Adults aged 19 or older with non-ST-segment elevation myocardial infarction and new or worsening dyspnea with pulmonary congestion (NYHA ≥2) who can give consent and are not in cardiogenic shock are ideal candidates.
Not a fit: Patients with cardiogenic shock, ST-elevation MI, apparently non-ischemic heart failure, pregnancy, planned or prior CABG, life expectancy under one year, or those who refuse participation are excluded and unlikely to benefit from the trial.
Why it matters
Potential benefit: If immediate angiography is superior, patients could have fewer deaths, fewer recurrent heart attacks, and fewer hospitalizations for heart failure over the following year.
How similar studies have performed: Evidence is limited and mixed: randomized trials largely excluded patients with acute heart failure, and only observational studies have examined early angiography in this subgroup with inconclusive results.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria: * Age ≥19 years * Non-ST-segment elevation myocardial infarction * New-onset or worsening of dyspnea (New York Heart Association class ≥2) * Pulmonary congestion * Patient's or guardian's consent after understanding the study Exclusion Criteria: * Cardiogenic shock at initial presentation * ST-segment elevation myocardial infarction * ST-segment elevation ≥0.1 mV in at least 2 contiguous leads, or * New onset left bundle branch block * Posterior wall myocardial infarction * Refractory angina * Life threatening ventricular arrhythmias * Life expectancy \<1 year * Apparently non-ischemic cause of HF * Pregnancy and lactation * History of coronary artery bypass grafting (CABG), or planned CABG * Patient's refusal to participate in study
Where this trial is running
Changwon and 19 other locations
- Gyeongsang National University Changwon Hospital — Changwon, South Korea (Recruiting)
- Keimyung University Dongsan Hospital — Daegu, South Korea (Recruiting)
- Kyungpook National University Hospital — Daegu, South Korea (Not_yet_recruiting)
- Yeongnam University Medical Center — Daegu, South Korea (Recruiting)
- Chungnam National University Hospital — Daejeon, South Korea (Recruiting)
- Chonnam National University Hospital — Gwangju, South Korea (Recruiting)
- Gwangju Veterans Hospital — Gwangju, South Korea (Recruiting)
- Kwangju Christian Hospital — Gwangju, South Korea (Not_yet_recruiting)
- Jeonbuk National University Hospital — Jeonju, South Korea (Recruiting)
- Gyeongsang National University Hospital — Jinju, South Korea (Recruiting)
- Dong-A University Hospital — Pusan, South Korea (Not_yet_recruiting)
- Seoul National University Bundang Hospital — Seongnam, South Korea (Not_yet_recruiting)
- Asan Medical Center — Seoul, South Korea (Recruiting)
- Kangbuk Samsung Medical Center — Seoul, South Korea (Withdrawn)
- Koera University Guro Hospital — Seoul, South Korea (Not_yet_recruiting)
- Korea University Anam Hospital — Seoul, South Korea (Recruiting)
- Samsung Medical Center — Seoul, South Korea (Recruiting)
- Seoul National University Hospital — Seoul, South Korea (Not_yet_recruiting)
- St. Carollo General Hospital — Suncheon, South Korea (Recruiting)
- Yonsei University, Wonju Severance Christian Hospital — Wŏnju, South Korea (Recruiting)
Study contacts
- Study coordinator: Youngkeun Ahn, Professor
- Email: cecilyk@hanmail.net
- Phone: 82-62-220-4764
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.