Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Nov;26(11):1142-1159.
doi: 10.1016/j.hlc.2017.02.031. Epub 2017 Apr 11.

Early Versus Delayed Invasive Strategies in High-Risk Non-ST Elevation Acute Coronary Syndrome Patients - A Systematic Literature Review and Meta-Analysis of Randomised Controlled Trials

Delara Javat  1 , Clare Heal  2 , Stefan Buchholz  3 , Zhihua Zhang  4
Affiliations
Review

Early Versus Delayed Invasive Strategies in High-Risk Non-ST Elevation Acute Coronary Syndrome Patients - A Systematic Literature Review and Meta-Analysis of Randomised Controlled Trials

Delara Javat et al. Heart Lung Circ. 2017 Nov.

Abstract

Rationale: It is unclear whether it is beneficial to perform angiography and/or percutaneous coronary intervention (PCI) as an early or delayed invasive strategy amongst high-risk non-ST elevation acute coronary syndrome (NSTEACS) patients.

Objective: To determine whether an early invasive strategy could further reduce recurrent myocardial infarction (MI) and early mortality compared to a delayed invasive strategy.

Methods and results: We searched MEDLINE, CINAHL and SCOPUS and performed a meta-analysis of nine RCTs with a total of 5274 patients. No statistically significant difference in recurrent MI (RR=0.56, 95% CI 0.17-1.87, p=0.35), early mortality (RR=0.81, 95% CI 0.62-1.05, p=0.11) and major bleeding (RR=0.85, 95% CI 0.66-1.09, p=0.21) was found between groups. A statistically significant reduction in recurrent ischaemia was found amongst patients treated with an early invasive strategy (RR 0.45, 95% CI 0.26-0.78, p=0.004). Subgroup analysis for recurrent MI showed a statistically significant reduction in risk amongst patients treated <24hours compared to≥24hours (RR=0.31, 95% CI 0.11-0.89, p=0.03).

Conclusion: This study suggests that an early invasive strategy may not further reduce recurrent MI and early mortality, but may significantly reduce recurrent ischaemia. However, the recurrent MI endpoint was associated with heterogeneity due to inconsistent MI definitions and strategy timings amongst the included trials. Furthermore, subgroup analysis demonstrated a significant reduction in recurrent MI amongst patients treated <24hours. Therefore, large clinical trials with consistent inclusion criteria are required to confirm whether intervention within 24hours reduces the rate of spontaneous and post-discharge recurrent MI. Future studies with long-term follow-up data are required to detect relevant differences in early mortality. Currently, it appears that stabilised high-risk NSTEACS patients may be safely delayed up to 24hours before undergoing an early invasive strategy.

Keywords: Angiography; Meta-analysis; Non-ST elevation acute coronary syndrome; Percutaneous coronary intervention; Timing.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

  • Elevated levels of autoantibodies against DNAJC2 in sera of patients with atherosclerotic diseases.
    Yoshida Y, Zhang XM, Wang H, Machida T, Mine S, Kobayashi E, Adachi A, Matsutani T, Kamitsukasa I, Wada T, Aotsuka A, Iwase K, Tomiyoshi G, Nakamura R, Shinmen N, Kuroda H, Takizawa H, Kashiwado K, Shin H, Akaogi Y, Shimada J, Nishi E, Ohno M, Takemoto M, Yokote K, Kitamura K, Iwadate Y, Hiwasa T. Yoshida Y, et al. Heliyon. 2020 Aug 19;6(8):e04661. doi: 10.1016/j.heliyon.2020.e04661. eCollection 2020 Aug. Heliyon. 2020. PMID: 32904265 Free PMC article.

MeSH terms

LinkOut - more resources