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Routine invasive versus selective invasive strategies for Non‐ST‐elevation acute coronary syndromes: An Updated meta‐analysis of randomized trials
Author(s) -
Elgendy Islam Y.,
Kumbhani Dharam J.,
Mahmoud Ahmed N.,
Wen Xuerong,
Bhatt Deepak L.,
Bavry Anthony A.
Publication year - 2016
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26679
Subject(s) - medicine , revascularization , randomized controlled trial , cardiology , myocardial infarction , odds ratio , unstable angina , acute coronary syndrome , confidence interval , angina , coronary artery disease , surgery
Objectives To perform an updated systematic review comparing a routine invasive strategy with a selective invasive strategy for patients with non‐ST‐elevation acute coronary syndromes (NSTE‐ACS) in the era of stents and antiplatelet therapy. Background Recent meta‐analyses comparing both strategies have shown conflicting results. Methods Electronic databases were searched for randomized trials that compared a routine invasive strategy (i.e., routine coronary angiography +/− revascularization) versus a selective invasive strategy (i.e., medical stabilization and coronary angiography +/− revascularization if objective evidence of ischemia or refractory ischemia) in patients with NSTE‐ACS. Summary odds ratios (OR) were primarily constructed using Peto's model. Results Twelve trials with 9,650 patients were included. Compared with a selective invasive strategy, a routine invasive strategy was associated with a reduction in the composite of all‐cause mortality or myocardial infarction (MI) [OR: 0.86, 95% confidence interval (CI) 0.77‐0.96] at a mean follow‐up of 39 months, primarily due to a reduction in the risk of MI (OR: 0.78, 95% CI: 0.68‐0.88). The risk of all‐cause mortality was non‐significantly reduced with a routine invasive strategy (OR: 0.88, 95% CI: 0.77‐1.01). The risk of recurrent angina was reduced with a routine invasive strategy (OR: 0.55, 95% CI: 0.49‐0.62), as well as the risk of future revascularization procedures (OR: 0.35, 95% CI: 0.30‐0.39). Conclusion In patients with NSTE‐ACS, a routine invasive strategy reduced the risk of ischemic events, including the risk of mortality or MI. Routine invasive therapy reduced the risk of recurrent angina and future revascularization procedures. © 2016 Wiley Periodicals, Inc.