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
References (28)
- et al.
ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarctiona report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the management of patients with unstable angina)
J Am Coll Cardiol
(2000) - et al.
Outcome at 1 year after an invasive compared with a non-invasive strategy in unstable coronary-artery diseasethe FRISC-II invasive randomised trial
Lancet
(2000) - et al.
A long-term perspective on the protective effects of an early invasive strategy in unstable coronary artery disease. Two year follow-up of the FRISC II invasive study
J Am Coll Cardiol
(2002) - et al.
Interventional versus conservative treatment for patients with unstable angina or non-ST-elevation myocardial infarctionthe Br Heart Foundation RITA-3 randomised trial
Lancet
(2002) - et al.
One-year results of the Thrombolysis In Myocardial Infarction (TIMI) IIIB clinical triala randomized comparison of tissue-type plasminogen activator versus placebo and early invasive versus conservative strategies in unstable angina and non-Q-wave myocardial infarction
J Am Coll Cardiol
(1995) - et al.
A prospective randomized trial of triage angiography in acute coronary syndromes ineligible for thrombolytic therapy. Results of the Medicine versus Angiography in Thrombolytic Exclusion (MATE) trial
J Am Coll Cardiol
(1998) Non-ST-elevation acute coronary syndromefuel for the invasive strategy
Lancet
(2002)- et al.
Clinical and quantitative coronary angiographic predictors of coronary restenosis. A comparative analysis from the balloon-to-stent era
J Am Coll Cardiol
(2001) - et al.
Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromesa meta-analysis of all major randomized clinical trials
Lancet
(2002) - et al.
Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary interventionthe PCI-CURE study
Lancet
(2001)
Is early invasive treatment of unstable coronary artery disease equally effective for both women and men?
J Am Coll Cardiol
N-terminal pro brain natriuretic peptide on admission for early stratification of patients with chest pain and no ST-segment elevation
J Am Coll Cardiol
Evaluation of B-type natriuretic peptide for risk assessment in unstable angina/non-ST-elevation myocardial infarction
J Am Coll Cardiol
“Routine invasive” versus “selective invasive” approaches to non-ST-segment elevation acute coronary syndromes management in the post-stent/platelet inhibition era
J Am Coll Cardiol
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2014, Canadian Journal of CardiologyNew predictors of mortality in the acute coronary syndromes
2013, American Journal of Emergency Medicine2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/Non-ST-Elevation myocardial infarction: A report of the american college of cardiology Foundation/American Heart Association task force on practice guidelines
2013, Journal of the American College of CardiologyCitation Excerpt :The TIMACS trial (432) compared early versus delayed angiography and intervention in patients with UA/NSTEMI (see Section Section 3.3.3.1), and demonstrated that a strategy of early angiography and intervention reduced ischemic complications, particularly among patients at high risk (defined by a GRACE score >140). Prior meta-analyses have concluded that routine invasive therapy is better than an initial conservative or selectively invasive approach (627–629). Mehta et al. (628) concluded that the routine invasive strategy resulted in an 18% relative reduction in death or MI, including a significant reduction in MI alone.