Outcomes in patients with non-ST-elevation acute coronary syndrome randomly assigned to invasive versus conservative treatment strategies: A meta-analysis

Abstract

OBJECTIVE:The goal of the present study was to compare the prognoses of patients with non-ST-elevation acute coronary syndromes who were treated with invasive or conservative treatment strategies.METHODS:We performed a meta-analysis of studies of patients with non-ST-elevation acute coronary syndromes to assess the benefits of an invasive strategy vs. a conservative strategy for short- and long-term survival. We searched PubMed for studies published from 1990 to November 2012 that investigated the effects of an invasive vs. conservative strategy in patients with non-ST-elevation acute coronary syndromes. The following search terms were used: “non-ST-elevation myocardial infarction”, “unstable angina”, “acute coronary syndromes”, “invasive strategy”, and “conservative strategy”. The primary endpoints were all-cause mortality at 30 days and 1 year.RESULTS:Seven published studies were included in the present meta-analysis. The pooled analyses show that an invasive strategy decreased the risk of death (risk ratio [0.839] [95% confidence interval {0.648-1.086}; I2, 86.46%] compared to a conservative strategy over a 30-day-period. Furthermore, invasive treatment also decreased patient mortality (risk ratio [0.276] [95% confidence interval {0.259-0.294}; I2, 94.58%]) compared to a conservative strategy for one year.CONCLUSION:In non-ST-elevation acute coronary syndromes, an invasive strategy is comparable to a conservative strategy for decreasing short- and long-term mortality rates.

Long-term Prognosis of Patients with Acute non-ST-segment Elevation Myocardial Infarction undergoing Different Treatment Strategies

“…[ 3 4 7 8 ] Our results showed that invasive strategy is still the most effective treatment to reduce long-term complications in NSTEMI patients. [ 5 6 10 12 ]…”

“…[ 3 ] The influence of different therapy strategies on mortality after non-ST-elevation ACS is still a matter of controversy. [ 3 4 5 6 7 8 ] To our knowledge, few studies have evaluated the long-term outcomes (>2 years) of invasive and conservative strategies in patients with acute NSTEMI in China. With the development of modern percutaneous coronary intervention (PCI) technology, we aimed to determine the long-term prognosis and disparities for NSTEMI patients in the real-world setting of different therapeutic strategies in the current era.…”

Admission route and use of invasive procedures during hospitalization for acute myocardial infarction: analysis of 2007-2011 National Health Insurance database

“…Therefore, the increasing proportion of NSTEMI cases might be also related to the observed increase in invasive procedures among total AMI admissions [ 18 ]. Invasive revascularization strategies have been proven to improve the outcome of AMI patients, in comparison with conservative or thrombolytic therapy [ 23 ]. The preference for invasive procedures over non-invasive medical treatment could increase the use of invasive procedures [ 24 ].…”

The influence of factors on five-year outcomes after acute coronary syndrome

“…Дополнительными факторами, которые самостоятельно прогрессируют и параллельно вносят весомый вклад в общий сосудистый риск, являются сахарный диабет 2 типа (СД 2 типа), хроническая болезнь почек (ХБП), ожирение и ряд других. Потому данные показатели применяются во многих шкалах неблагоприятного отдаленного сердечно-сосудистого прогноза [4].…”

“…Средний возраст мужчин составил 56,3±5,2, женщин 52,1±5,3 лет. Для постановки диагноза ОКС использовались критерии Европейского кардиологического общества [4,6]. тивность тромболитической терапии, а также ОНП: rs619203, rs10757278, rs1333049, rs499818, rs137625, rs4804611, rs17465637, rs2549513…”