Early Versus Delayed Invasive Strategies for Patients with Non-ST Elevation Acute Coronary Syndrome: An Updated Meta-analysis of Randomized Clinical Trials
Tuesday, May 21, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
Madeline Michalopulos, M.D.
,
University of Tennessee Health Science Center, Memphis, TN
Samuel Latham, MD
,
UTHSC, Cardiology, Memphis, TN
Pooja Sona Jagadish, M.D.
,
University of Tennessee Health Science Center, Memphis, TN
James Turner
,
University of Tennessee health Science Center Memphis TN, Memphis, TN
Vinh Duong
,
University of Tennessee health Science Center Memphis TN, Memphis, TN
Babar Khan
,
UTHSC, Cardiology, Memphis, TN
Rahman Shah, M.D.
,
University of Tennessee health Science Center Memphis TN, Memphis, TN
Background:
In patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), an invasive strategy is the standard of care. However, the optimal timing of this strategy is not well defined: in randomized clinical trials (RCTs), an invasive coronary angiography has been performed after as much as 72 hours. In recent months, new RCTs (i.e., the VERDICT and EARLY trials) have been reported on the background of contemporary anti-platelet therapy. Therefore, we performed an updated meta-analysis of RCTs comparing the safety and efficacy of an early invasive strategy (within 24 hours) with a late invasive strategy.
Methods:
Scientific databases were searched for RCTs, and pooled risk ratios (RRs) were determined using a random effects model.
Results:
Data from 16 trials including 9622 patients were analyzed. An early invasive strategy decreased risk for recurrent/refractory ischemia by 46% (RR, 0.54; 95% CI, 0.36–0.80;
p = 0.002). However, no differences in the risks of all-cause death (RR, 0.89; 95% CI, 0.75–1.04;
p = 0.15), recurrent MI (RR, 0.85; 95% CI, 0.59–1.23;
p = 0.39), or bleeding (RR, 0.89; 95% CI, 0.75–1.04;
p = 0.15) were found (Figures). An early invasive strategy was also associated with decreased hospitalization time.
Conclusions:
Based on this updated meta-analysis with the largest sample to date, for patients with NSTE-ACS, an early invasive strategy, compared to a delayed invasive strategy, improved recurrent/refractory ischemia without affecting mortality rate and was associated with decreased hospitalization time.
