1999Acute coronary syndromesIntervention2457 patients

FRISC II

Therapy group: Invasive strategy · Therapy: Early invasive vs non-invasive strategy in unstable coronary disease

In unstable coronary artery disease, an early invasive strategy reduced death or myocardial infarction and improved angina versus non-invasive management, especially in high-risk patients.

Published in Lancet (1999)

Question: Is an early invasive strategy superior to a non-invasive strategy in patients with unstable coronary artery disease?
Design: Prospective, randomized, multicenter study in 58 Scandinavian hospitals including 2457 patients (median age 66 years, 70% men). Dalteparin or placebo was also assessed for 3 months; follow-up was 6 months, with intention-to-treat analysis.
Population: Patients with unstable coronary artery disease, with ECG signs of ischemia or raised biochemical markers of myocardial damage.
Intervention: Early invasive strategy: coronary angiography within the first 7 days (done in 96%) and revascularization within the first 10 days (71%).
Control: Non-invasive strategy, with angiography in 10% and early revascularization in 9% of patients.
Primary outcome: Composite of death or myocardial infarction at 6 months.
Results: Death or MI at 6 months: 9.4% in the invasive group vs 12.1% in the non-invasive group (RR 0.78; 95% CI 0.62-0.98; p=0.031). MI alone was lower (7.8% vs 10.1%; RR 0.77; 95% CI 0.60-0.99; p=0.045) and mortality was non-significantly lower (1.9% vs 2.9%; RR 0.65; 95% CI 0.39-1.09; p=0.10).
Safety: Angina symptoms and readmissions were halved by the invasive strategy.
Conclusion: An early invasive strategy reduced death or myocardial infarction at 6 months, with the greatest benefit in high-risk patients, independent of dalteparin treatment.
Why it matters: It supported early angiography and revascularization as the preferred strategy in most patients with unstable coronary artery disease with ischemic ECG changes or raised markers.

Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.

Generated on October 18, 2026

Sources

Original publication on PubMed (PMID 10475181) ↗Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC II prospective randomised multicentre study. FRagmin and Fast Revascularisation during InStability in Coronary artery disease Investigators.
Journal article (DOI) ↗

Videos explaining it

EHJ Today - The FRISC II 15 Trial

ESC · European Society of Cardiology ↗12:51Video page

Source: European Society of Cardiology · YouTube
Date: 6 Sept 2016
Audio: English
Subtitles: MultilingualYouTube
Audio transl.: None

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