Regular paperInvasive therapy along with glycoprotein IIb/IIIa inhibitors and intracoronary stents improves survival in non–ST-segment elevation acute coronary syndromes: a meta-analysis and review of the literature
Section snippets
Literature review
We searched the MEDLINE, EMBASE, CRISP, metaRegister of Controlled Trials, and Cochrane databases for randomized clinical trials from 1990 through 2003 using the Medical Subject Heading terms “angina, unstable,” “myocardial infarction,” “angioplasty, transluminal, percutaneous coronary,” “stents,” and “platelet glycoprotein glycoprotein IIb/IIIa complex.” We also hand-searched relevant journals, corresponded with investigators and experts in the field, and used the Science Citation Index to
Baseline characteristics
The characteristics of the 5 studies that were included in the meta-analysis are listed in Table 1. In all, 6,766 patients were enrolled from June 1996 until March 2000 from many North American and European countries. Of these, 3,371 were randomized to the invasive arm and 3,395 to the conservative therapy arm. The baseline characteristics of patients randomized to invasive and conservative therapies were similar within each study. The median ages of participants ranged from 61 to 66 years. The
Discussion
Our meta-analysis suggests a trend toward a 20% reduction in 6- to 12-month mortality in UA/NSTEMI patients randomized to a routine invasive approach. There was no obvious difference in 1-month mortality between invasive and conservative management, but 2-year mortality was reduced 23% with invasive therapy. The composite end point of death or MI was significantly reduced throughout all follow-up periods. Sex differences were apparent, with a clear reduction in death or MI at 6 to 12 months in
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