PMID- 17885517
OWN - NLM
STAT- MEDLINE
DCOM- 20080123
LR  - 20090528
IS  - 1558-2027 (Print)
IS  - 1558-2027 (Linking)
VI  - 8
IP  - 10
DP  - 2007 Oct
TI  - Patient risk profile and benefit from an invasive approach in the initial 
      management of non-ST-segment elevation acute coronary syndrome.
PG  - 799-802
AB  - BACKGROUND: Routine use of an invasive strategy (IS) has been shown to exceed a 
      conservative strategy in reducing myocardial infarction (MI), angina and 
      re-hospitalization rate in patients with non-ST elevation acute coronary syndrome 
      (NSTEACS). The present study aimed to analyse, by use of randomized trials data, 
      whether the risk profile of patients with NSTEACS influences the survival benefit 
      of the IS over a conservative strategy from randomization to end of follow-up 
      (range 6-24 months). METHODS: Eight studies were identified from 1970 to 2005. A 
      fixed effect-meta-regression analysis for: (i) the log-odds ratio on death and 
      (ii) the log-odds ratio on death/MI against the odds of death/MI in the control 
      group was made. RESULTS: IS was associated with a significant reduction in 
      death/MI [12% versus 13.7%, odds ratio (OR) = 0.86, P = 0.009], but not in 
      mortality (5.1% versus 5.5%, OR = 0.92, P = 0.34). There was evidence of 
      heterogeneity in the outcome mortality (P = 0.06 for heterogeneity) and the 
      composite of death/MI (P = 0.01 for heterogeneity). Sensitivity analysis 
      demonstrated that the source of heterogeneity was significantly related to the 
      outlier VANQWISH trial. When the latter was removed from the analysis, IS was 
      related to a significant reduction of both death (3.9% versus 4.9%, OR = 0.81, P 
      = 0.04, P heterogeneity = 0.35) and death/MI (10% versus 12.1%, OR = 0.81, P = 
      0.001, P heterogeneity = 0.07). CONCLUSIONS: The main finding of this 
      meta-analysis is that, compared to a conservative strategy, the benefits of IS 
      for the management of NSTEACS in terms of death/MI reduction are related to the 
      patient's risk profile.
FAU - Tarantini, Giuseppe
AU  - Tarantini G
AD  - Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 
      Padova, Italy. giuseppe.tarantini.1@unipd.it
FAU - Razzolini, Renato
AU  - Razzolini R
FAU - Ramondo, Angelo
AU  - Ramondo A
FAU - Napodano, Massimo
AU  - Napodano M
FAU - Manica, Anna
AU  - Manica A
FAU - Favaretto, Enrico
AU  - Favaretto E
FAU - Iliceto, Sabino
AU  - Iliceto S
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PL  - United States
TA  - J Cardiovasc Med (Hagerstown)
JT  - Journal of cardiovascular medicine (Hagerstown, Md.)
JID - 101259752
SB  - IM
MH  - Acute Coronary Syndrome/mortality/*surgery
MH  - Humans
MH  - Myocardial Infarction/prevention & control
MH  - *Myocardial Revascularization
MH  - Randomized Controlled Trials as Topic
MH  - Regression Analysis
EDAT- 2007/09/22 09:00
MHDA- 2008/01/24 09:00
CRDT- 2007/09/22 09:00
PHST- 2007/09/22 09:00 [pubmed]
PHST- 2008/01/24 09:00 [medline]
PHST- 2007/09/22 09:00 [entrez]
AID - 01244665-200710000-00005 [pii]
AID - 10.2459/JCM.0b013e3280110605 [doi]
PST - ppublish
SO  - J Cardiovasc Med (Hagerstown). 2007 Oct;8(10):799-802. doi: 
      10.2459/JCM.0b013e3280110605.