Long-term outcome of a routine versus selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome a meta-analysis of individual patient data
| Autor: | Keith A A, Fox, Tim C, Clayton, Peter, Damman, Stuart J, Pocock, Robbert J, de Winter, Jan G P, Tijssen, Bo, Lagerqvist, Lars, Wallentin |
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| Rok vydání: | 2010 |
| Předmět: |
Male
Time Factors Risk Assessment Severity of Illness Index Electrocardiography Cause of Death Myocardial Revascularization Humans Thrombolytic Therapy Acute Coronary Syndrome Angioplasty Balloon Coronary Coronary Artery Bypass Aged Probability Proportional Hazards Models Randomized Controlled Trials as Topic Aged 80 and over Patient Selection Age Factors Middle Aged Survival Analysis Multivariate Analysis Female Stents Platelet Aggregation Inhibitors Follow-Up Studies |
| Zdroj: | Journal of the American College of Cardiology. 55(22) |
| ISSN: | 1558-3597 |
| Popis: | This study was designed to determine: 1) whether a routine invasive (RI) strategy reduces the long-term frequency of cardiovascular death or nonfatal myocardial infarction (MI) using a meta-analysis of individual patient data from all randomized studies with 5-year outcomes; and 2) whether the results are influenced by baseline risk.Pooled analyses of randomized trials show early benefit of routine intervention, but long-term results are inconsistent. The differences may reflect differing trial design, adjunctive therapies, and/or limited power. This meta-analysis (n = 5,467 patients) is designed to determine whether outcomes are improved despite trial differences.Individual patient data, with 5-year outcomes, were obtained from FRISC-II (Fragmin and Fast Revascularization during Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Randomized Trial of a Conservative Treatment Strategy Versus an Interventional Treatment Strategy in Patients with Unstable Angina) trials for a collaborative meta-analysis. A Cox regression analysis was used for a multivariable risk model, and a simplified integer model was derived.Over 5 years, 14.7% (389 of 2,721) of patients randomized to an RI strategy experienced cardiovascular death or nonfatal MI versus 17.9% (475 of 2,746) in the selective invasive (SI) strategy (hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.71 to 0.93; p = 0.002). The most marked treatment effect was on MI (10.0% RI strategy vs. 12.9% SI strategy), and there were consistent trends for cardiovascular deaths (HR: 0.83, 95% CI: 0.68 to 1.01; p = 0.068) and all deaths (HR: 0.90, 95% CI: 0.77 to 1.05). There were 2.0% to 3.8% absolute reductions in cardiovascular death or MI in the low- and intermediate-risk groups and an 11.1% absolute risk reduction in highest-risk patients.An RI strategy reduces long-term rates of cardiovascular death or MI and the largest absolute effect in seen in higher-risk patients. |
| Databáze: | OpenAIRE |
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