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Meta-Analysis
. 2020 Feb;95(2):185-193.
doi: 10.1002/ccd.28280. Epub 2019 May 21.

Meta-analysis of optimal timing of coronary intervention in non-ST-elevation acute coronary syndrome

Mahmoud Barbarawi  1 , Babikir Kheiri  1 , Yazan Zayed  1 , Owais Barbarawi  2 , Adam Chahine  1 , Tarek Haykal  1 , Ashok K Kanugula  1 , Ghassan Bachuwa  1 , Mohammad L Alkotob  3 , Deepak L Bhatt  4
Affiliations
Meta-Analysis

Meta-analysis of optimal timing of coronary intervention in non-ST-elevation acute coronary syndrome

Mahmoud Barbarawi et al. Catheter Cardiovasc Interv. 2020 Feb.

Abstract

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.

Keywords: delayed invasive; early invasive; meta-analysis; non-ST-elevation.

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References

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