PMID- 28515027
OWN - NLM
STAT- MEDLINE
DCOM- 20180529
LR  - 20181202
IS  - 1444-2892 (Electronic)
IS  - 1443-9506 (Linking)
VI  - 26
IP  - 11
DP  - 2017 Nov
TI  - 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.
PG  - 1142-1159
LID - S1443-9506(17)30292-5 [pii]
LID - 10.1016/j.hlc.2017.02.031 [doi]
AB  - 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.
CI  - Copyright (c) 2017 Australian and New Zealand Society of Cardiac and Thoracic 
      Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). 
      Published by Elsevier B.V. All rights reserved.
FAU - Javat, Delara
AU  - Javat D
AD  - Department of Cardiology, Mackay Base Hospital, Brisbane, Qld, Australia; Mackay 
      Clinical School, School of Medicine and Dentistry, James Cook University, Mackay 
      Campus, Brisbane, Qld, Australia. Electronic address: delara.javat@my.jcu.edu.au.
FAU - Heal, Clare
AU  - Heal C
AD  - Mackay Clinical School, School of Medicine and Dentistry, James Cook University, 
      Mackay Campus, Brisbane, Qld, Australia; Mackay Institute for Research and 
      Innovation (MIRI), Brisbane, Qld, Australia.
FAU - Buchholz, Stefan
AU  - Buchholz S
AD  - Department of Cardiology, Mackay Base Hospital, Brisbane, Qld, Australia; Mackay 
      Clinical School, School of Medicine and Dentistry, James Cook University, Mackay 
      Campus, Brisbane, Qld, Australia; ​HeartCare Partners, Sunshine Coast University 
      Private Hospital, Brisbane, Qld, Australia.
FAU - Zhang, Zhihua
AU  - Zhang Z
AD  - Department of Cardiology, Mackay Base Hospital, Brisbane, Qld, Australia; Mackay 
      Clinical School, School of Medicine and Dentistry, James Cook University, Mackay 
      Campus, Brisbane, Qld, Australia.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20170411
PL  - Australia
TA  - Heart Lung Circ
JT  - Heart, lung & circulation
JID - 100963739
SB  - IM
MH  - *Acute Coronary Syndrome/diagnostic imaging/mortality/surgery
MH  - *Coronary Angiography
MH  - Disease-Free Survival
MH  - Female
MH  - Humans
MH  - Male
MH  - *Non-ST Elevated Myocardial Infarction/diagnostic imaging/mortality/surgery
MH  - *Percutaneous Coronary Intervention
MH  - Randomized Controlled Trials as Topic
MH  - Survival Rate
MH  - Time Factors
OTO - NOTNLM
OT  - Angiography
OT  - Meta-analysis
OT  - Non-ST elevation acute coronary syndrome
OT  - Percutaneous coronary intervention
OT  - Timing
EDAT- 2017/05/19 06:00
MHDA- 2018/05/31 06:00
CRDT- 2017/05/19 06:00
PHST- 2016/04/01 00:00 [received]
PHST- 2017/02/18 00:00 [revised]
PHST- 2017/02/23 00:00 [accepted]
PHST- 2017/05/19 06:00 [pubmed]
PHST- 2018/05/31 06:00 [medline]
PHST- 2017/05/19 06:00 [entrez]
AID - S1443-9506(17)30292-5 [pii]
AID - 10.1016/j.hlc.2017.02.031 [doi]
PST - ppublish
SO  - Heart Lung Circ. 2017 Nov;26(11):1142-1159. doi: 10.1016/j.hlc.2017.02.031. Epub 
      2017 Apr 11.