Key result
An early invasive strategy (<12 hours) did not significantly reduce all-cause death (RR 0.90; 95% CI 0.77-1.06) compared to a delayed strategy in patients with NSTE-ACS.
Why the study?
Patients with NSTE-ACS benefit from coronary intervention, but the optimal timing for an invasive strategy is not well defined.
Does an early invasive strategy (<12 hours) reduce all-cause death, re-MI, major bleeding, or refractory ischemia compared to a delayed invasive strategy in patients with NSTE-ACS?
Meta-Analysis (n=8,586)
Does an early invasive strategy (<12 hours) reduce all-cause death, re-MI, major bleeding, or refractory ischemia compared to a delayed invasive strategy in patients with NSTE-ACS?
Answers are grounded in this paper and cite their sources.
An early invasive strategy (<12 hours) does not improve overall clinical outcomes in NSTE-ACS but significantly reduces the composite of death or re-MI in high-risk patients with GRACE scores >140 or elevated cardiac markers.
OBJECTIVE: Patients with non-ST elevation acute coronary syndrome (NSTE-ACS) benefit from coronary intervention, but the optimal timing for an invasive strategy is not well defined. This study aimed to determine whether an early invasive strategy (<12 hours) is superior to a delayed invasive strategy. METHODS: Twelve studies of nine randomized, controlled trials of 8586 patients were included. RESULTS: There were no significant differences in all-cause death (risk ratio [95% confidence interval]) (0.90, [0.77-1.06), re-myocardial infarction (re-MI) (0.95 [0.70-1.29]), major bleeding (0.97 [0.77-1.23]), and refractory ischemia (0.74 [0.53-1.05]) when we compared use of early and delayed invasive strategies. Furthermore, analysis of the effect of the chosen strategy on high-risk patients showed that the rate of composite death or re-MI was significantly decreased in patients with either a Global Registry of Acute Coronary Events (GRACE) risk score >140 or with elevated troponin levels (risk ratio 0.82 [0.72-0.92]; risk ratio 0.84 [0.76-0.93], respectively). CONCLUSIONS: This meta-analysis shows that an early angiographic strategy does not improve clinical outcome in patients with NSTE-ACS. An early invasive strategy might reduce the rate of composite death or re-MI in high-risk patients with GRACE risk scores >140 or elevated cardiac markers.
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Li et al. (2020) conducted a meta-analysis in non-ST elevation acute coronary syndrome (NSTE-ACS) (n=8,586). Early invasive strategy (<12 hours) vs. Delayed invasive strategy was evaluated on all-cause death (RR 0.90, 95% CI 0.77-1.06). An early invasive strategy (<12 hours) did not significantly reduce all-cause death (RR 0.90; 95% CI 0.77-1.06) compared to a delayed strategy in patients with NSTE-ACS.
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