Meta-analysis of optimal timing of coronary intervention in non-ST-elevation acute coronary syndrome
| Autor: | Ashok Kumar Kanugula, Mohammad Luay Alkotob, Tarek Haykal, Owais Barbarawi, Deepak L. Bhatt, Yazan Zayed, Ghassan Bachuwa, Babikir Kheiri, Adam Chahine, Mahmoud Barbarawi |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Acute coronary syndrome medicine.medical_specialty Time Factors Subgroup analysis 030204 cardiovascular system & hematology Cochrane Library law.invention Time-to-Treatment 03 medical and health sciences 0302 clinical medicine Percutaneous Coronary Intervention Randomized controlled trial law Recurrence Risk Factors Internal medicine Cause of Death medicine Humans Radiology Nuclear Medicine and imaging 030212 general & internal medicine Myocardial infarction Acute Coronary Syndrome Non-ST Elevated Myocardial Infarction Aged Randomized Controlled Trials as Topic Aged 80 and over business.industry ST elevation General Medicine Middle Aged medicine.disease Treatment Outcome Relative risk Female Cardiology and Cardiovascular Medicine business Mace |
| Zdroj: | Catheterization and cardiovascular interventions : official journal of the Society for Cardiac AngiographyInterventionsREFERENCES. 95(2) |
| ISSN: | 1522-726X |
| Popis: | 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).Coronary angiography is recommended for patients with NSTE-ACS, however, the optimal timing for this remains controversial.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).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 GRACE140 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).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. |
| Databáze: | OpenAIRE |
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