Key result
Early invasive intervention reduces all-cause mortality ~32% vs delayed strategies in NSTEMI.
Why the study?
The optimal timing of invasive management for NSTEMI remains uncertain, particularly because most available evidence comes from developed or high-resource healthcare settings.
Does an early invasive strategy reduce major adverse cardiovascular events compared to a delayed invasive strategy in adults with NSTEMI?
Meta-Analysis (n=526,450)
Yes
Does an early invasive strategy reduce major adverse cardiovascular events compared to a delayed invasive strategy in adults with NSTEMI?
Effect estimate: RR 0.68 (95% CI 0.61-0.76)
p-value: p=<0.00001
Early invasive intervention within 24 hours for NSTEMI significantly reduces all-cause mortality and heart failure rehospitalization compared to delayed strategies.
Supports early invasive strategy in NSTEMI; confirms mortality benefit in meta-analysis of ten studies.
In recent years, early invasive strategies for non-ST-elevation myocardial infarction (NSTEMI) have been increasingly studied as a means of promptly identifying and treating culprit coronary lesions. However, the optimal timing of invasive management remains uncertain, particularly because most available evidence is derived from developed or high-resource healthcare settings. This systematic review and meta-analysis compared early vs. delayed invasive strategies in adults with NSTEMI for major adverse cardiovascular events and key secondary outcomes. A Population, Intervention, Comparison, Outcome framework guided eligibility criteria, and relevant studies were identified through PubMed/MEDLINE, Cochrane, and Embase. Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed, and quantifiable outcomes were analyzed using RevMan v5.4.1 (The Cochrane Collaboration, London, UK). Ten studies were included. Overall, five of 10 studies reported significant benefits favoring early or immediate invasive strategies, four found no significant benefit in adjusted or long-term analyses, and one reported increased adverse events with early intervention. Meta-analysis showed that early intervention significantly reduced all-cause mortality (risk ratio (RR) = 0.68, 95% confidence interval (CI): 0.61-0.76, p < 0.00001) and rehospitalization due to heart failure (RR = 0.41, 95% CI: 0.29-0.58, p < 0.0001). However, no significant benefit was observed for nonfatal acute myocardial infarction (RR = 0.62, 95% CI: 0.18-2.11, p = 0.45) or cardiovascular death at five years (RR = 0.99, 95% CI: 0.66-1.48, p = 0.94). Early invasive intervention within 24 hours may improve selected NSTEMI outcomes, especially mortality and heart-failure rehospitalization. However, because the included studies were predominantly from developed countries, these findings may not be directly applicable to low-resource settings where catheterization facilities, specialists, and rapid referral systems are limited. Further evidence from low- and middle-income regions is needed.
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Kamble et al. (2026) conducted a meta-analysis in Non-ST Elevation Myocardial Infarction (NSTEMI) (n=526,450). Early invasive strategy vs. Delayed/late invasive strategy was evaluated on All-cause mortality (RR 0.68, 95% CI 0.61-0.76, p=<0.00001). Early invasive intervention significantly reduced all-cause mortality by 32% (RR 0.68) compared to delayed strategies in patients with NSTEMI.
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