PMID- 31761637
OWN - NLM
STAT- MEDLINE
DCOM- 20210715
LR  - 20210715
IS  - 1878-0938 (Electronic)
IS  - 1878-0938 (Linking)
VI  - 21
IP  - 11
DP  - 2020 Nov
TI  - Timing of Percutaneous Coronary Intervention in Non-ST Elevation Acute Coronary 
      Syndrome - Meta-Analysis and Systematic Review of Literature.
PG  - 1398-1404
LID - S1553-8389(19)30653-0 [pii]
LID - 10.1016/j.carrev.2019.10.004 [doi]
AB  - BACKGROUND: Percutaneous coronary intervention (PCI) is the standard procedure of 
      care for most patients with non-ST elevation acute coronary syndrome (NSTE-ACS). 
      However, the timing of PCI remains unclear. We performed this meta-analysis with 
      available randomized controlled trials (RCTs) to compare early versus late 
      coronary intervention in patients with NSTE-ACS. METHOD: A total of 13 RCTs were 
      selected through PubMed/MEDLINE via OVID, EMBASE via OVID and Cochrane Central 
      Register of Controlled Trials (inception to October 2018) search. Outcomes were 
      analyzed using the relative risk (RR) and 95% CI. Pooled RRs were determined 
      using M-H random-effects model, which can account for between study 
      heterogeneity. RESULTS: We included 13 RCTs with 11,972 patients were included. 
      There were 7101 patients were randomized into early invasive group and 4871 in 
      late invasive group. There was a significant decrease in myocardial infarction 
      with long-term follow up in early invasive group compared to the delayed invasive 
      group (RR 0.847 [95% CI 0.74-0.95], p = 0.009) with no difference in mortality 
      between early and late invasive group (5.41% vs 6.49%, RR 0.882 [95% CI, 
      0.76-1.02]). On subgroup analysis, data was available from 6 RCTs for GRACE 
      (Global Registry of Acute Coronary Events) score and 8 RCTs for elevated 
      troponin. Early intervention led to decrease in adverse events in patients with 
      elevated GRACE score > 140 (Mantel-Haenszel pooled RR 0.88 [95% CI 0.82-0.95], 
      p-value 0.002) but no difference was seen in patients with elevated troponin. 
      CONCLUSION: It can be postulated from these results that early invasive strategy 
      leads to decrease in myocardial infarction but without significant decrease in 
      mortality. In patients with elevated GRACE score (>140), early intervention did 
      show a trend towards decrease in major adverse cardiac events, whereas in 
      patients with elevated troponin alone, similar association was not observed. 
      However, adequately powered randomized controlled trial is necessary to validate 
      these findings.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Awan, Ahmad
AU  - Awan A
AD  - Department of Cardiology, Howard University Hospital, Washington, DC, United 
      States of America. Electronic address: aawan@huhosp.org.
FAU - Ogunti, Richard
AU  - Ogunti R
AD  - Department of Internal Medicine, Howard University Hospital, Washington, DC, 
      United States of America.
FAU - Fatima, Urooj
AU  - Fatima U
AD  - Department of Cardiology, Howard University Hospital, Washington, DC, United 
      States of America.
FAU - Gonzalez, Hilda
AU  - Gonzalez H
AD  - Department of Cardiology, Howard University Hospital, Washington, DC, United 
      States of America.
FAU - Ganta, Nitheesha
AU  - Ganta N
AD  - Department of Internal Medicine, Howard University Hospital, Washington, DC, 
      United States of America.
FAU - Rizwan, Muhammad
AU  - Rizwan M
AD  - Department of Internal Medicine, Howard University Hospital, Washington, DC, 
      United States of America.
FAU - Mahajan, Ankit
AU  - Mahajan A
AD  - Department of Cardiology, Howard University Hospital, Washington, DC, United 
      States of America.
FAU - Opoku-Asare, Isaac
AU  - Opoku-Asare I
AD  - Department of Cardiology, Howard University Hospital, Washington, DC, United 
      States of America.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20191018
PL  - United States
TA  - Cardiovasc Revasc Med
JT  - Cardiovascular revascularization medicine : including molecular interventions
JID - 101238551
SB  - IM
MH  - Acute Coronary Syndrome
MH  - Humans
MH  - Myocardial Infarction
MH  - *Percutaneous Coronary Intervention
MH  - Randomized Controlled Trials as Topic
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Coronary intervention
OT  - PCI
OT  - Time factors
EDAT- 2019/11/26 06:00
MHDA- 2021/07/16 06:00
CRDT- 2019/11/26 06:00
PHST- 2019/07/27 00:00 [received]
PHST- 2019/09/18 00:00 [revised]
PHST- 2019/10/02 00:00 [accepted]
PHST- 2019/11/26 06:00 [pubmed]
PHST- 2021/07/16 06:00 [medline]
PHST- 2019/11/26 06:00 [entrez]
AID - S1553-8389(19)30653-0 [pii]
AID - 10.1016/j.carrev.2019.10.004 [doi]
PST - ppublish
SO  - Cardiovasc Revasc Med. 2020 Nov;21(11):1398-1404. doi: 
      10.1016/j.carrev.2019.10.004. Epub 2019 Oct 18.