Early Invasive Strategy in Non-ST-Elevation Acute Coronary Syndrome With Congestive Heart Failure　― A Systematic Review and Meta-Analysis ―

Background: Congestive heart failure (CHF) is associated with worse clinical outcomes in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS); however, the optimal timing of invasive intervention in NSTE-ACS with CHF remains unclear. In this study, we assessed the impact of early vs. delayed invasive strategies on mortality and cardiac events by synthesizing a systematic review of randomized controlled trials of patients with NSTE-ACS. Methods and Results: We searched MEDLINE, CENTRAL, and the Web of Science for randomized controlled trials comparing early and delayed invasive strategies in patients with NSTE-ACS and CHF, published before February 2023. Observational studies were excluded. The primary endpoint was a composite of all-cause mortality and myocardial infarction at 2 years. Two eligible studies, including 310 participants, were identified. The primary endpoint occurred in 40 (24.5%) of 163 patients in the early invasive strategy group, compared with 39 (26.5%) of 147 patients in the delayed invasive strategy group, and the effect of an early invasive strategy on the primary outcome was uncertain (risk ratio 0.95 [95% confidence interval 0.66-1.37]). The certainty of the evidence was rated very low. Conclusions: The effects of an early invasive strategy in patients with NSTE-ACS and CHF remains uncertain, with no clear reduction in composite outcome of mortality and myocardial infarction at 2 years compared with delayed intervention.