Immediate coronary angiography (CAG) is recommended for patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) complicated by acute decompensated heart failure (ADHF). The EARLY-HF trial (ClinicalTrials.gov, NCT04810806) was conducted to evaluate the optimal timing of coronary angiography (CAG) in this population.

Patients were randomized in a 1:1 ratio to receive either immediate CAG within 2 h of randomization (immediate CAG group) or delayed CAG following stabilization of heart failure (HF) (delayed CAG group). The primary outcome was the composite of 12-month composite of all-cause mortality, nonfatal myocardial infarction (MI), and recurrent ischemia.

A total of 85 patients were randomly divided into the immediate CAG group (43 patients) or delayed CAG group (42 patients, performed at a median of 82.7 h post-randomization). The EARLY-HF trial was prematurely terminated due to COVID-19-related constraints. Revascularization was performed in 67.4 % and 69.1 % of patients in the immediate and delayed CAG groups, respectively. The incidence of the primary outcome was 35.6 % vs. 24.2 % in the two groups, respectively (P = 0.240, HR [95 % CI] =1.60 [0.72–3.57]). 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 (23.7 % vs. 7.3 %, P = 0.039).