PMID- 33115315
OWN - NLM
STAT- MEDLINE
DCOM- 20210514
LR  - 20210514
IS  - 1473-2300 (Electronic)
IS  - 0300-0605 (Print)
IS  - 0300-0605 (Linking)
VI  - 48
IP  - 10
DP  - 2020 Oct
TI  - Early invasive strategy for non-ST elevation acute coronary syndrome: a 
      meta-analysis of randomized, controlled trials.
PG  - 300060520966500
LID - 10.1177/0300060520966500 [doi]
LID - 0300060520966500
AB  - OBJECTIVE: Patients with non-ST elevation acute coronary syndrome (NSTE-ACS) 
      benefit from coronary intervention, but the optimal timing for an invasive 
      strategy is not well defined. This study aimed to determine whether an early 
      invasive strategy (<12 hours) is superior to a delayed invasive strategy. 
      METHODS: Twelve studies of nine randomized, controlled trials of 8586 patients 
      were included. RESULTS: There were no significant differences in all-cause death 
      (risk ratio [95% confidence interval]) (0.90, [0.77-1.06), re-myocardial 
      infarction (re-MI) (0.95 [0.70-1.29]), major bleeding (0.97 [0.77-1.23]), and 
      refractory ischemia (0.74 [0.53-1.05]) when we compared use of early and delayed 
      invasive strategies. Furthermore, analysis of the effect of the chosen strategy 
      on high-risk patients showed that the rate of composite death or re-MI was 
      significantly decreased in patients with either a Global Registry of Acute 
      Coronary Events (GRACE) risk score >140 or with elevated troponin levels (risk 
      ratio 0.82 [0.72-0.92]; risk ratio 0.84 [0.76-0.93], respectively). CONCLUSIONS: 
      This meta-analysis shows that an early angiographic strategy does not improve 
      clinical outcome in patients with NSTE-ACS. An early invasive strategy might 
      reduce the rate of composite death or re-MI in high-risk patients with GRACE risk 
      scores >140 or elevated cardiac markers.
FAU - Li, Ying
AU  - Li Y
AD  - Department of Cardiology, Tianjin Fifth Central Hospital, Tianjin, China.
FAU - Wang, Cuancuan
AU  - Wang C
AD  - Department of Cardiology, Tianjin Fifth Central Hospital, Tianjin, China.
FAU - Nan, Yue
AU  - Nan Y
AD  - Department of Cardiology, Tianjin Fifth Central Hospital, Tianjin, China.
FAU - Zhao, Hui
AU  - Zhao H
AD  - Department of Cardiology, Tianjin Fifth Central Hospital, Tianjin, China.
FAU - Cao, Zhongnan
AU  - Cao Z
AD  - Department of Cardiology, Tianjin Fifth Central Hospital, Tianjin, China.
FAU - Du, Xinping
AU  - Du X
AUID- ORCID: 0000-0003-0039-1235
AD  - Department of Cardiology, Tianjin Fifth Central Hospital, Tianjin, China.
FAU - Wang, Kuan
AU  - Wang K
AD  - Department of Cardiology, Tianjin Fifth Central Hospital, Tianjin, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PL  - England
TA  - J Int Med Res
JT  - The Journal of international medical research
JID - 0346411
SB  - IM
MH  - *Acute Coronary Syndrome
MH  - Coronary Angiography
MH  - Humans
MH  - *Myocardial Infarction
MH  - Odds Ratio
MH  - Randomized Controlled Trials as Topic
MH  - Risk Factors
MH  - Treatment Outcome
PMC - PMC7607294
OTO - NOTNLM
OT  - Invasive strategy
OT  - composite death
OT  - coronary angiography
OT  - early intervention
OT  - myocardial infarction
OT  - non-ST elevation acute coronary syndrome
COIS- Declaration of conflicting interest: The authors declare that there is no 
      conflict of interest.
EDAT- 2020/10/30 06:00
MHDA- 2021/05/15 06:00
PMCR- 2020/10/28
CRDT- 2020/10/29 05:28
PHST- 2020/10/29 05:28 [entrez]
PHST- 2020/10/30 06:00 [pubmed]
PHST- 2021/05/15 06:00 [medline]
PHST- 2020/10/28 00:00 [pmc-release]
AID - 10.1177_0300060520966500 [pii]
AID - 10.1177/0300060520966500 [doi]
PST - ppublish
SO  - J Int Med Res. 2020 Oct;48(10):300060520966500. doi: 10.1177/0300060520966500.