Routine invasive versus selective invasive strategies for Non-ST-elevation acute coronary syndromes: An Updated meta-analysis of randomized trials

Islam Y. Elgendy, Dharam J. Kumbhani, Ahmed N. Mahmoud, Xuerong Wen, Deepak L. Bhatt, Anthony A. Bavry

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

Objectives: To perform an updated systematic review comparing a routine invasive strategy with a selective invasive strategy for patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) in the era of stents and antiplatelet therapy. Background: Recent meta-analyses comparing both strategies have shown conflicting results. Methods: Electronic databases were searched for randomized trials that compared a routine invasive strategy (i.e., routine coronary angiography +/− revascularization) versus a selective invasive strategy (i.e., medical stabilization and coronary angiography +/− revascularization if objective evidence of ischemia or refractory ischemia) in patients with NSTE-ACS. Summary odds ratios (OR) were primarily constructed using Peto's model. Results: Twelve trials with 9,650 patients were included. Compared with a selective invasive strategy, a routine invasive strategy was associated with a reduction in the composite of all-cause mortality or myocardial infarction (MI) [OR: 0.86, 95% confidence interval (CI) 0.77-0.96] at a mean follow-up of 39 months, primarily due to a reduction in the risk of MI (OR: 0.78, 95% CI: 0.68-0.88). The risk of all-cause mortality was non-significantly reduced with a routine invasive strategy (OR: 0.88, 95% CI: 0.77-1.01). The risk of recurrent angina was reduced with a routine invasive strategy (OR: 0.55, 95% CI: 0.49-0.62), as well as the risk of future revascularization procedures (OR: 0.35, 95% CI: 0.30-0.39). Conclusion: In patients with NSTE-ACS, a routine invasive strategy reduced the risk of ischemic events, including the risk of mortality or MI. Routine invasive therapy reduced the risk of recurrent angina and future revascularization procedures.

Original languageEnglish (US)
Pages (from-to)765-774
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Volume88
Issue number5
DOIs
StatePublished - Nov 1 2016

Keywords

  • acute coronary syndrome
  • meta-analysis
  • mortality
  • myocardial infarction
  • revascularization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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