Early invasive strategy (< 24 h) significantly reduced mortality compared to a delayed invasive strategy in patients with non-ST-segment elevation acute coronary syndromes (OR 0.78).
Meta-Analysis (n=6,624)
Does immediate or early invasive coronary revascularization reduce mortality and other adverse cardiovascular events compared to a delayed invasive strategy in patients with NSTE-ACS?
An early invasive strategy (<24h) in NSTE-ACS may reduce mortality and refractory ischemia, while an immediate approach (<2h) appears to lower the risk of major bleeding compared to delayed intervention.
Effect estimate: OR 0.78 (95% CI 0.61-0.99)
p-value: p=0.05
Invasive coronary revascularization has been shown to improve prognoses in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), but the optimal timing of intervention remains unclear. This meta-analysis is to evaluate the outcomes in immediate (<2h), early (<24h) and delayed invasive group and find out which is the optimal timing of intervention in NSTE-ACS patients. Studies were identified through a computerized literature search of Medline, PubMed Central, Embase, the Cochrane Library and CNKI. Data were extracted for populations, interventions, outcomes, and risk of bias. All-cause mortality was the prespecified primary end point. The longest follow-up available in each study was chosen. The odds ratio(OR) with 95% CI was the effect measure. In the comparision between early and delayed intervention, we found that early intervention led to a statistical significant decrease in mortality rate (n = 6624; OR 0.78, 95% CI: 0.61–0.99) and refractory ischemia (n = 6127; OR 0.50, 95% CI: 0.40–0.62) and a nonsignificant decrease in MI, major bleeding and revascularization. In the analysis comparing immediate and delayed invasive approach, we found: immediate intervention significantly reduced major bleeding (n = 1217; OR 0.46, 95% CI: 0.23–0.93) but led to a nonsignificant decrease in mortality rate, refractory ischemia and revascularization and a nonsignificant increase in MI. In conclusion, early invasive strategy may reduce the risk of refractory ischemia, while immediate invasive therapy shows a benefit in reducing the risk of major bleeding. In addition, immediate invasive therapy may lead to a lower mortality rate, however, this conclusion is not stable.
Li et al. (Mon,) conducted a meta-analysis in Non-ST-Segment Elevation Acute Coronary Syndromes (NSTE-ACS) (n=6,624). Early invasive strategy (< 24 h) vs. Delayed invasive strategy (≥ 24 h) was evaluated on All-cause mortality (OR 0.78, 95% CI 0.61-0.99, p=0.05). Early invasive strategy (< 24 h) significantly reduced mortality compared to a delayed invasive strategy in patients with non-ST-segment elevation acute coronary syndromes (OR 0.78).