Early Versus Delayed Percutaneous Coronary Intervention for Patients With Non-ST Segment Elevation Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Clinical Trials
AbstractStudies assessing the timing of percutaneous coronary interventions (PCI) in patients with Non-ST segment elevation Acute Coronary Syndromes (NSTEACS) have failed to generate a consensus on how early PCI should be performed in such patients.
Purpose: This meta-analysis compares clinical outcomes at 30 days in NSTE-ACS patients undergoing PCI within 24 hours of presentation (early PCI) with those receiving PCI more than 24 hours after presentation (delayed PCI).
Data Sources: Data were extracted from searches of MEDLINE (1990–2010) and Google scholar and from scrutiny of abstract booklets from major cardiology meetings (1990–2010).
Study selection: Randomized clinical trials (RCTs) that included the composite endpoint of death and non-fatal myocardial infarction (MI) at 30 days after PCI were considered.
Data Extraction: Two independent reviewers extracted data using standard forms. The effects of early and delayed PCI were analyzed by calculating pooled estimates for death, non-fatal MI, bleeding, repeat revascularization and the composite endpoint of death or non-fatal MI at 30 days. Univariate analysis of each of these variables was used to create odds ratios.
Data Synthesis: Seven studies with a total of 13,762 patients met the inclusion criteria. There was no significant difference in the odds of the composite endpoint of death or non-fatal MI at 30 days between patients undergoing early PCI and those receiving delayed PCI (OR 0,83: 95%CI 0,62–1,10). Patients receiving delayed PCI experienced a 33% reduction in the odds of repeat revascularization at 30 days compared to those undergoing early PCI (OR 1,33: 95%CI 1,14–1,56: p=0, 0004).Conversely, patients undergoing early PCI experienced lower odds of bleeding than those receiving delayed PCI (OR 0,76: 95%CI 0,63–0,91: p=0.0003).
Conclusions: In NSTE-ACS patients early PCI doesn’t reduce the odds of the composite endpoint of death or non-fatal MI at 30 day. This strategy is associated with lower odds of bleeding and higher odds of repeat revascularization at 30 days than a strategy of delayed PCI.
Keywords:acute coronary syndrome, percutaneous coronary intervention, timing
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