1. Routine vs selective invasive strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials
- Author
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Petr Widimsky, Rudolf Spacek, David M. Hunt, William E. Boden, Salim Yusuf, Keith A.A. Fox, Peter A. McCullough, Eugene Braunwald, Lars Wallentin, Shamir R. Mehta, and Christopher P. Cannon
- Subjects
medicine.medical_specialty ,Randomization ,medicine.medical_treatment ,Myocardial Infarction ,Revascularization ,Coronary Angiography ,law.invention ,Angina ,Randomized controlled trial ,Fibrinolytic Agents ,law ,Internal medicine ,Myocardial Revascularization ,Medicine ,Humans ,Myocardial infarction ,Angina, Unstable ,Aged ,Randomized Controlled Trials as Topic ,business.industry ,Unstable angina ,General Medicine ,Odds ratio ,Middle Aged ,medicine.disease ,Confidence interval ,Surgery ,business - Abstract
ContextPatients with unstable angina or non–ST-segment elevation myocardial infarction (NSTEMI) can be cared for with a routine invasive strategy involving coronary angiography and revascularization or more conservatively with a selective invasive strategy in which only those with recurrent or inducible ischemia are referred for acute intervention.ObjectiveTo conduct a meta-analysis that compares benefits and risks of routine invasive vs selective invasive strategies.Data SourcesRandomized controlled trials identified through search of MEDLINE and the Cochrane databases (1970 through June 2004) and hand searching of cross-references from original articles and reviews.Study SelectionTrials were included that involved patients with unstable angina or NSTEMI who received a routine invasive or a selective invasive strategy.Data ExtractionMajor outcomes of death and myocardial infarction (MI) occurring from initial hospitalization to the end of follow-up were extracted from published results of eligible trials.Data SynthesisA total of 7 trials (N = 9212 patients) were eligible. Overall, death or MI was reduced from 663 (14.4%) of 4604 patients in the selective invasive group to 561 (12.2%) of 4608 patients in the routine invasive group (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.72-0.93; P = .001). There was a nonsignificant trend toward fewer deaths (6.0% vs 5.5%; OR, 0.92; 95% CI, 0.77-1.09; P = .33) and a significant reduction in MI alone (9.4% vs 7.3%; OR, 0.75; 95% CI, 0.65-0.88; P
- Published
- 2005