Comparing the effectiveness and safety of an early versus a delayed invasive strategy in patients with non-ST elevation acute coronary syndrome.

This study compared the effectiveness and safety of an early and a delayed invasive strategy (IS) in patients with non-ST elevation acute coronary syndrome (NSTE-ACS). The data showed that there were no significant differences in the risk of death, heart attacks, stroke rates, major bleeding, or revascularization between early and delayed IS. Early IS significantly reduced the risk of recurrent ischemia and length of hospital stay in these patients.

Acute coronary syndrome (ACS) is caused by reduced blood flow to the heart. ACS can result in a heart attack. Patients with ACS usually take medication to reduce the risk of blockages in the coronary arteries. Non-ST elevation acute coronary syndrome (NSTE-ACS) occurs when there is a partially blocked artery in the heart and the blood flow to the heart stops and chest pains occur. The recommended treatments for NSTE-ACS include medications and an invasive strategy (IS). Common ISs for treating NSTE-ACS are coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).

CABG is a surgery used to improve blood flow to the heart. A healthy artery is connected to the blocked artery to create a new path for blood to flow to the heart. PCI (or angioplasty) is a non-surgical procedure where narrow or blocked arteries are widened or unblocked using stents. Timely intervention therapy is essential to improve the prognosis of patients with NSTE-ACS.  However, the optimal timing of an IS is still unclear in long-term follow-up. Whether an early IS improves clinical outcomes compared with a delayed IS in patients with NSTE-ACS is still unclear.

This study analyzed 17 other studies and involved a total of 10209 patients with NSTE-ACS. 5215 patients received an early IS. 4994 patients received a delayed IS.

There were no significant differences in the risk of death, heart attacks, stroke rates, major bleeding, or revascularization between the 2 groups.

The risk of recurrent ischemia (insufficient blood supply to the tissues) and length of hospital stay were significantly reduced with an early IS.

This study concluded that there were no significant differences in the risk of death, heart attacks, stroke rates, major bleeding, or revascularization between early and delayed IS in patients with NSTE-ACS. Early IS significantly reduced the risk of recurrent ischemia and length of hospital stay in these patients.

This study looked back in time at medical records. The studies analyzed had different criteria for including patients, different follow-up periods, and different timing of IS.