Premium
Meta‐analysis of optimal timing of coronary intervention in non‐ST‐elevation acute coronary syndrome
Author(s) -
Barbarawi Mahmoud,
Kheiri Babikir,
Zayed Yazan,
Barbarawi Owais,
Chahine Adam,
Haykal Tarek,
Kanugula Ashok K.,
Bachuwa Ghassan,
Alkotob Mohammad L.,
Bhatt Deepak L.
Publication year - 2020
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.28280
Subject(s) - medicine , mace , acute coronary syndrome , myocardial infarction , incidence (geometry) , meta analysis , randomized controlled trial , relative risk , cardiology , hazard ratio , cochrane library , confidence interval , percutaneous coronary intervention , physics , optics
Objectives We conducted a meta‐analysis of randomized controlled trials (RCTs) to compare the efficacy and safety of early versus delayed invasive management of non‐ST‐elevation acute coronary syndrome (NSTE‐ACS). Background Coronary angiography is recommended for patients with NSTE‐ACS, however, the optimal timing for this remains controversial. Methods Literature search of Pubmed/MEDLINE, Cochrane Library, and Embase for all RCTs that compared early with delayed invasive approaches in treating NSTE‐ACS was conducted by two independent authors. Primary outcome was major adverse cardiovascular events (MACE), while the secondary outcomes included cardiovascular mortality, all‐cause mortality, myocardial infarction (MI), and bleeding events. The Mantel‐Haenszel random‐effects model was used to calculate risk ratios (RRs) and 95% confidence intervals (CIs). Results We included 14 RCTs (9,637 patients, mean age 65.4, 67% males). The early invasive strategy was associated with a lower incidence of MACE compared with the delayed invasive strategy (RR 0.65, 95%CI 0.49–0.87; p = .003). Subgroup analysis according to GRACE score showed a lower incidence of MACE with early invasive strategies in GRACE >140 patients ( p for interaction = .002). Furthermore, recurrent ischemia was lower in patients with an early invasive strategy (RR 0.42, 95%CI 0.26–0.69; p < .0005). In contrast, there were no significant differences in all‐cause mortality, cardiovascular mortality, MI, or bleeding events between groups (all p > .05). Conclusions Among patients with NSTE‐ACS, an early invasive strategy was associated with lower incidence of MACE and recurrent ischemia compared with delayed invasive strategy. There were no significant differences in all‐cause mortality, cardiovascular mortality, MI, or bleeding events between groups.