Immediate/Early vs. Delayed Invasive Strategy for Patients with Non-ST-Segment Elevation Acute Coronary Syndromes: A Systematic Review and Meta-analysis
- 1Guang’anmen Hospital, China Academy of Chinese medical Science, China
- 2Queen Elizabeth Hospital (QEH), Hong Kong
- 3Masonic Medical Research Laboratory, United States
- 4Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, China
Invasive coronary revascularization has been shown to improve prognoses in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), but the optimal timing of intervention remains unclear.
This meta-analysis is to evaluate the outcomes in immediate (<2h), early (<24h) and delayed invasive group and find out which is the optimal timing of intervention in NSTE-ACS patients. Studies were identified through a computerized literature search of Medline, PubMed Central, Embase, the Cochrane Library and CNKI. Data were extracted for populations, interventions, outcomes, and risk of bias. All-cause mortality was the prespecified primary end point. The longest follow-up available in each study was chosen. The odds ratio(OR) with 95% CI was the effect measure. In the comparision between early and delayed intervention, we found that early intervention led to a statistical significant decrease in mortality rate (n = 6624; OR 0.78, 95% CI: 0.61–0.99) and refractory ischemia (n = 6127; OR 0.50, 95% CI: 0.40–0.62) and a nonsignificant decrease in MI, major bleeding and revascularization. In the analysis comparing immediate and delayed invasive approach, we found: immediate intervention significantly reduced major bleeding (n = 1217; OR 0.46, 95% CI: 0.23–0.93) but led to a nonsignificant decrease in mortality rate, refractory ischemia and revascularization and a nonsignificant increase in MI. In conclusion, early invasive strategy may reduce the risk of refractory ischemia, while immediate invasive therapy shows a benefit in reducing the risk of major bleeding. In addition, immediate invasive therapy may lead to a lower mortality rate, however, this conclusion is not stable.
Keywords: Non-ST-segment elevation acute coronary syndrome, interventional cardiology, Meta-analysis, PCI in acute coronary syndromes, Myocardial Infarction, timing
Received: 26 May 2017;
Accepted: 08 Nov 2017.
Edited by:Jing-Yan Han, Peking University, China
Reviewed by:Qiaobing Huang, Southern Medical University, China
Bao-liang Sun, Taishan Medical University, China
Copyright: © 2017 Xing, Li, Xiong, Cho, Hu, Zhang, Gao and Shang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Prof. Yanwei Xing, Guang’anmen Hospital, China Academy of Chinese medical Science, Beijing, China, firstname.lastname@example.org
Prof. Hongcai Shang, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China, email@example.com