Myocardial Infarction (MI)TIMING-AHFNCT07002164
Timing of Coronary Angiography in NSTEMI Complicated by Acute HF
A study testing Immediate coronary angiography and Delayed coronary angiography in people with Myocardial Infarction (MI) and Heart Failure, run by Chonnam National University Hospital at 20 sites in South Korea.
Trial summary
Study objectives: To determine the optimal timing of coronary angiography (CAG) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) complicated by acute decompensated heart failure (AHF). Read more about this study
- Who is it for?
- Ages 19 years and older
- Conditions the study is for
- Myocardial Infarction (MI), Heart Failure
- What is being tested?
- Immediate coronary angiography and Delayed coronary angiography
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 780 participants
- Where
- 20 sitesSouth Korea
- Study dates
- 15 Jul 2025to 30 Apr 2032
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 19 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- 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
Who cannot join
- 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
Show all 12Show fewer
- 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
Trial locations and contacts
20 sites in 1 country. Contact the study team or a site near you to ask about taking part.
20 sites in 1 country
South Korea20 sites, 19 recruiting
- Recruiting
Gyeongsang National University Changwon Hospital
Changwon
- Recruiting
Keimyung University Dongsan Hospital
Daegu
- Not yet recruiting
Kyungpook National University Hospital
Daegu
- Recruiting
Yeongnam University Medical Center
Daegu
- Recruiting
Chungnam National University Hospital
Daejeon
- Recruiting
Chonnam National University Hospital
Gwangju
Youngkeun Ahn, Professor
Min Chul Kim, Professor
- Recruiting
Gwangju Veterans Hospital
Gwangju
- Not yet recruiting
Kwangju Christian Hospital
Gwangju
- Recruiting
Jeonbuk National University Hospital
Jeonju
- Recruiting
Gyeongsang National University Hospital
Jinju
- Not yet recruiting
Dong-A University Hospital
Pusan
- Not yet recruiting
Seoul National University Bundang Hospital
Seongnam
- Recruiting
Asan Medical Center
Seoul
- Withdrawn
Kangbuk Samsung Medical Center
Seoul
- Not yet recruiting
Koera University Guro Hospital
Seoul
- Recruiting
Korea University Anam Hospital
Seoul
- Recruiting
Samsung Medical Center
Seoul
- Not yet recruiting
Seoul National University Hospital
Seoul
- Recruiting
St. Carollo General Hospital
Suncheon
- Recruiting
Yonsei University, Wonju Severance Christian Hospital
Wŏnju
About this study
Official title: 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
Study objectives:
To determine the optimal timing of coronary angiography (CAG) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) complicated by acute decompensated heart failure (AHF). The primary objective of this trial is to test the hypothesis that immediate CAG ≤2 hours after establishment of NSTEMI diagnosis would result in a significant reduction in primary composite outcome of death from any cause, non-fatal myocardial infarction (MI), or hospitalization for heart failure (HF) at 12 months after randomization as compared with delayed CAG after stabilization.
Read more
Study hypothesis:
Immediate CAG ≤2 hours after establishment of NSTEMI diagnosis would result in a significant reduction in primary composite outcome of death from any cause, non-fatal myocardial infarction (MI), or hospitalization for heart failure (HF) at 12 months after randomization as compared with delayed CAG after stabilization.
Background:
Although current guidelines recommend early CAG within 2 hours for patients with NSTEMI complicated by AHF, many patients with NSTEMI complicated by AHF did not receive early CAG. However, no randomized clinical trials have evaluated the optimal timing of CAG in patients with NSTEMI complicated by AHF. Therefore, the investigators aimed to perform a prospective, investigator-initiated, open-label, muilticenter trial to compare the efficacy and safety between immediate CAG (CAG <2 hours after establishment of NSTEMI diagnosis) and delayed CAG after stabilization (i.e. improved dyspnea and disappearance of pulmonary congestion) in participants with NSTEMI complicated by AHF.
Study procedure:
Following the establishment of NSTEMI diagnosis, participants fulfilling the eligibility criteria will be randomized at a ratio of 1:1 to immediate CAG ≤2 hours after randomization or delayed CAG after stabilization on another day during hospitalization.
Read the detailed description
Acute decompensated heart failure (AHF) is frequently encountered in patients with non-ST-segment elevation myocardial infarction (NSTEMI), and it is known to be associated with worse clinical outcomes that those without heart failure (HF). Although current guidelines recommend immediate invasive strategy for patients with NSTEMI complicated by AHF, its evidence is lack. It is difficult to decide whether to perform early coronary angiography (CAG) according to the guidelines in these high-risk patients due to the risk of procedural complications. Furthermore, the most of randomized trials regarding the timing of CAG in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) have excluded these patients, therefore, there is lack of evidence for performing immediate CAG in such cases. In clinical practice, many patients with NSTEMI complicated by AHF did not receive early CAG. There are only two observational studies which investigated this issue. In the Korean nationwide registry data, a total of 1,027 patients with NSTEMI complicated by AHF were analyzed, and 14.5% among study population underwent early CAG within 2 hours according to the guidelines. All-cause mortality at 12 months was not significantly different irrespective of CAG timing. In other single-center study, early CAG <24 hours was associated with a lower risk of adverse cardiac outcomes compared with delayed CAG ≥24 hours after admission.
Several studies have demonstrated improved clinical outcomes in high-risk patients with NSTE-ACS undergoing early CAG, whereas others have found no significant differences in clinical outcomes. Randomized clinical trials, such as SISCA, ISAR-COOL, RIDDLE-NSTEMI and EARLY, have demonstrated the advantages of early CAG compared to delayed invasive approach (i.e. CAG after stabilization) in high-risk patients with NSTE-ACS. The other trials regarding this issue have failed to show the superiority of early CAG over delayed invasive approach. However, no randomized clinical trials have evaluated the optimal timing of CAG in patients with NSTEMI complicated by AHF.
Therefore, the investigators aimed to perform a prospective, investigator-initiated, open-label, muilticenter trial to compare the efficacy and safety between immediate CAG (CAG <2 hours after establishment of NSTEMI diagnosis) and delayed CAG after stabilization (i.e. improved dyspnea and disappearance of pulmonary congestion) in participants with NSTEMI complicated by AHF.
- Conditions
- Myocardial Infarction (MI), Heart Failure
- Being tested
- Immediate coronary angiography, Delayed coronary angiography
- Keywords
- Non-ST-segment elevation myocardial infarction, Acute decompensated heart failure, Coronary angiography, Timing
- Medical subject headings
- Myocardial Infarction, Heart Failure
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Immediate coronary angiographyProcedure or surgery
Immediate coronary angiography ≤2 hours after randomization
Delayed coronary angiographyProcedure or surgery
Delayed coronary angiography after stabilization
| Study group | Role | What they receive |
|---|---|---|
| Immediate coronary angiography within 2 hours after diagnosis of non-ST-segment elevation myocardial | Experimental | Coronary angiography will be performed within 2 hours after diagnosis of non-ST-segment elevation myocardial infarction. Receives: Procedure: Immediate coronary angiography |
| Delayed coronary angiography after stabilization of acute decompensated heart failure | Active comparator | Coronary angiography will be performed after disappearance of symptoms and signs of acute decompensated heart failure. Receives: Procedure: Delayed coronary angiography |
What is being measured
The primary outcome is the main question the study is designed to answer.
A cumulative incidence rate of all-cause death, non-fatal myocardial infarction (MI), or hospitalization for heart failure (HF)
Measured: 1 year
Secondary outcomes (13)
A cumulative incidence rate of all-cause death, non-fatal MI, or hospitalization for HF
Measured: 1, 6, 24, 36 months
All-cause death
Measured: 1, 6, 12, 24, 36 months
Non-fatal MI
Measured: 1, 6, 12, 24, 36 months
Hospitalization for HF
Measured: 1, 6, 12, 24, 36 months
Cardiovascular death
Measured: 1, 6, 12, 24, 36 months
Recurrent ischemia
Recurrent ischemia is defined as repeated episodes of ischemic symptoms needing emergent coronary angiography with any of the following signs:
- Electrocardiographic changes indicating myocardial ischemia
- Ventricular arrhythmias
- New-onset pulmonary edema
- Cardiogenic shock
Measured: 1, 6, 12, 24, 36 months
All unplanned revascularization
Measured: 1, 6, 12, 24, 36 months
Definite or probable stent thrombosis
Measured: 1, 6, 12, 24, 36 months
Stroke
Measured: 1, 6, 12, 24, 36 months
Major bleeding by Bleeding Academic Research Consortium
Measured: 1, 6, 12, 24, 36 months
Acute kidney injury (AKI) and AKI requiring renal replacement therapy
Measured: Up to 7 days
In-hospital death rate from any cause
Measured: Up to 30 days
In-hospital death rate from cardiovascular cause
Measured: Up to 30 days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted3 Jun 2025
- Study start15 Jul 2025
- Primary completion30 Apr 2030 (estimated)
- Study completion30 Apr 2032 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Myocardial Infarction (MI)Studies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 780 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Chonnam National University Hospital
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Min Chul Kim, Chonnam National University Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07002164
- Sponsor's protocol ID
- CNUH-2025-100
- Acronym
- TIMING-AHF
- Status last verified
- Mar 2026
- First submitted
- 17 May 2025
- Last updated
- 19 Mar 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 19 Mar 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- 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
- ClinicalTrials.gov ID
- NCT07002164
- Acronym / sponsor ID
- TIMING-AHF / CNUH-2025-100
- Conditions
- Myocardial Infarction (MI), Heart Failure
- Keywords
- Non-ST-segment elevation myocardial infarction, Acute decompensated heart failure, Coronary angiography, Timing
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 780 participants (estimated)
- Lead sponsor
- Chonnam National University HospitalUniversity, hospital or other
- Study start
- 15 Jul 2025 (actual)
- Primary completion
- 30 Apr 2030 (estimated)
- Study completion
- 30 Apr 2032 (estimated)
- First posted
- 3 Jun 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Study objectives:
To determine the optimal timing of coronary angiography (CAG) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) complicated by acute decompensated heart failure (AHF). The primary objective of this trial is to test the hypothesis that immediate CAG ≤2 hours after establishment of NSTEMI diagnosis would result in a significant reduction in primary composite outcome of death from any cause, non-fatal myocardial infarction (MI), or hospitalization for heart failure (HF) at 12 months after randomization as compared with delayed CAG after stabilization.
Study hypothesis:
Immediate CAG ≤2 hours after establishment of NSTEMI diagnosis would result in a significant reduction in primary composite outcome of death from any cause, non-fatal myocardial infarction (MI), or hospitalization for heart failure (HF) at 12 months after randomization as compared with delayed CAG after stabilization.
Background:
Although current guidelines recommend early CAG within 2 hours for patients with NSTEMI complicated by AHF, many patients with NSTEMI complicated by AHF did not receive early CAG. However, no randomized clinical trials have evaluated the optimal timing of CAG in patients with NSTEMI complicated by AHF. Therefore, the investigators aimed to perform a prospective, investigator-initiated, open-label, muilticenter trial to compare the efficacy and safety between immediate CAG (CAG <2 hours after establishment of NSTEMI diagnosis) and delayed CAG after stabilization (i.e. improved dyspnea and disappearance of pulmonary congestion) in participants with NSTEMI complicated by AHF.
Study procedure:
Following the establishment of NSTEMI diagnosis, participants fulfilling the eligibility criteria will be randomized at a ratio of 1:1 to immediate CAG ≤2 hours after randomization or delayed CAG after stabilization on another day during hospitalization.
Detailed description
Acute decompensated heart failure (AHF) is frequently encountered in patients with non-ST-segment elevation myocardial infarction (NSTEMI), and it is known to be associated with worse clinical outcomes that those without heart failure (HF). Although current guidelines recommend immediate invasive strategy for patients with NSTEMI complicated by AHF, its evidence is lack. It is difficult to decide whether to perform early coronary angiography (CAG) according to the guidelines in these high-risk patients due to the risk of procedural complications. Furthermore, the most of randomized trials regarding the timing of CAG in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) have excluded these patients, therefore, there is lack of evidence for performing immediate CAG in such cases. In clinical practice, many patients with NSTEMI complicated by AHF did not receive early CAG. There are only two observational studies which investigated this issue. In the Korean nationwide registry data, a total of 1,027 patients with NSTEMI complicated by AHF were analyzed, and 14.5% among study population underwent early CAG within 2 hours according to the guidelines. All-cause mortality at 12 months was not significantly different irrespective of CAG timing. In other single-center study, early CAG <24 hours was associated with a lower risk of adverse cardiac outcomes compared with delayed CAG ≥24 hours after admission.
Several studies have demonstrated improved clinical outcomes in high-risk patients with NSTE-ACS undergoing early CAG, whereas others have found no significant differences in clinical outcomes. Randomized clinical trials, such as SISCA, ISAR-COOL, RIDDLE-NSTEMI and EARLY, have demonstrated the advantages of early CAG compared to delayed invasive approach (i.e. CAG after stabilization) in high-risk patients with NSTE-ACS. The other trials regarding this issue have failed to show the superiority of early CAG over delayed invasive approach. However, no randomized clinical trials have evaluated the optimal timing of CAG in patients with NSTEMI complicated by AHF.
Therefore, the investigators aimed to perform a prospective, investigator-initiated, open-label, muilticenter trial to compare the efficacy and safety between immediate CAG (CAG <2 hours after establishment of NSTEMI diagnosis) and delayed CAG after stabilization (i.e. improved dyspnea and disappearance of pulmonary congestion) in participants with NSTEMI complicated by AHF.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Immediate coronary angiography within 2 hours after diagnosis of non-ST-segment elevation myocardial | Experimental | Procedure: Immediate coronary angiographyCoronary angiography will be performed within 2 hours after diagnosis of non-ST-segment elevation myocardial infarction. |
| Delayed coronary angiography after stabilization of acute decompensated heart failure | Active comparator | Procedure: Delayed coronary angiographyCoronary angiography will be performed after disappearance of symptoms and signs of acute decompensated heart failure. |
Who may qualify
- Ages
- 19 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- 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
Key exclusion criteria (12 listed)
- Cardiogenic shock at initial presentation
- ST-segment elevation myocardial infarction
- Refractory angina
- Life threatening ventricular arrhythmias
- Life expectancy <1 year
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Immediate coronary angiographyImmediate coronary angiography ≤2 hours after randomization | Procedure or surgery | Immediate coronary angiography within 2 hours after diagnosis of non-ST-segment elevation myocardial |
| Delayed coronary angiographyDelayed coronary angiography after stabilization | Procedure or surgery | Delayed coronary angiography after stabilization of acute decompensated heart failure |
Primary outcome
A cumulative incidence rate of all-cause death, non-fatal myocardial infarction (MI), or hospitalization for heart failure (HF)
Time frame: 1 year
13 secondary outcomes
A cumulative incidence rate of all-cause death, non-fatal MI, or hospitalization for HF
Time frame: 1, 6, 24, 36 months
All-cause death
Time frame: 1, 6, 12, 24, 36 months
Non-fatal MI
Time frame: 1, 6, 12, 24, 36 months
Hospitalization for HF
Time frame: 1, 6, 12, 24, 36 months
Cardiovascular death
Time frame: 1, 6, 12, 24, 36 months
Recurrent ischemia
Time frame: 1, 6, 12, 24, 36 months
All unplanned revascularization
Time frame: 1, 6, 12, 24, 36 months
Definite or probable stent thrombosis
Time frame: 1, 6, 12, 24, 36 months
Stroke
Time frame: 1, 6, 12, 24, 36 months
Major bleeding by Bleeding Academic Research Consortium
Time frame: 1, 6, 12, 24, 36 months
Acute kidney injury (AKI) and AKI requiring renal replacement therapy
Time frame: Up to 7 days
In-hospital death rate from any cause
Time frame: Up to 30 days
In-hospital death rate from cardiovascular cause
Time frame: Up to 30 days
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 19 Mar 2026.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
20 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Immediate coronary angiography and Delayed coronary angiography in people with Myocardial Infarction (MI) and Heart Failure, run by Chonnam National University Hospital at 20 sites in South Korea.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 19 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 20 sites in South Korea. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Youngkeun Ahn, Professor (82-62-220-4764 ext. 82-62-220-4764, cecilyk@hanmail.net), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
A cumulative incidence rate of all-cause death, non-fatal myocardial infarction (MI), or hospitalization for heart failure (HF) (time frame: 1 year). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Mar 2026.