Key result
An early invasive strategy significantly reduced all-cause mortality to 4.9% compared to 6.5% with a conservative strategy at 2 years in patients with UA/NSTEMI.
Why the study?
Does an early invasive strategy reduce major adverse cardiovascular events in patients with UA/NSTEMI compared to a conservative strategy?
Does an early invasive strategy reduce major adverse cardiovascular events in patients with UA/NSTEMI compared to a conservative strategy?
An early invasive strategy improves long-term outcomes in intermediate to high-risk patients with UA/NSTEMI compared to a conservative approach, supporting current guideline recommendations.
May support early invasive strategy in UA/NSTEMI; leaves open confirmation from contemporary RCTs.
Acute Coronary Syndrome (ACS) comprises three related disorders. In ST-elevation myocardial infarction (STEMI) rapid restoration of flow in the infarct-related artery (via pharmacological or mechanical means) is of paramount importance to minimize necrosis. In patients presenting with Unstable Angina / Non-ST-segment myocardial infarction (UA/NSTEMI) the correct choice of the initial treatment strategy (early invasive vs. selective invasive vs. conservative) is imperative in assuring optimal patient outcomes. Various risk prediction models can assist in the decision making process in an individual patient. The timing of angiography and revascularization in patients selected for the early invasive strategy are important factors in determining the long-term outcome in this patient population subset.
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Vorster et al. (2017) conducted a review in Unstable Angina / Non-ST-segment myocardial infarction (UA/NSTEMI). Early invasive strategy vs. Selective invasive (conservative) strategy was evaluated on All-cause mortality (RR 0.75, 95% CI 0.63-0.90, p=0.001). An early invasive strategy significantly reduced all-cause mortality to 4.9% compared to 6.5% with a conservative strategy at 2 years in patients with UA/NSTEMI.
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