Thiele H et al. – This meta–analysis assessed the effect of invasive strategy timing on mortality in patients with non–ST–elevation acute coronary syndrome (NSTE–ACS). In this analysis, an early invasive strategy was not associated with lower mortality compared with delayed invasive strategy in all patients with NSTE–ACS; however, particularly in high–risk patients, an early invasive strategy showed to reduce mortality.

Methods

• A literature search in public domain was performed to identify all randomized clinical trials comparing early versus delayed invasive strategy in patients with NSTE–ACS.
• All trials that reported all–cause mortality at least 30 days after in–hospital randomization and for which the trial investigators agreed to collaborate were included in the analysis.
• Random–effects models were used to pool hazard ratios (HRs).

Results

• A total of 8 trials including 5324 patients with a median follow–up of 180 days (interquartile range [IQR] 180–360 days) were included for assessment.
• No significant mortality reduction in the early invasive group was observed compared with the delayed invasive group (HR 0.81, 95% CI 0.64–1.03; P = .0879).
• A prespecified analysis in high–risk patients demonstrated that an early invasive strategy in patients with elevated cardiac biomarkers at baseline (HR 0.761, 95% CI 0.581–0.996), diabetes (HR 0.67, 0.45–0.99), a Global Registry of Acute Coronary Events (GRACE) risk score >140 (HR 0.70, 0.52–0.95), and age of 75 years (HR 0.65, 0.46–0.93) was associated with lower mortality.