Abstract 16721: A Meta-Analysis of Early versus Delayed Revascularization Among Patients With Non-st-segment Elevation Myocardial Infarction

Abstract

Introduction: Several randomized control trials (RCTs) have compared early versus delayed coronary revascularization in non-ST-segment elevation myocardial infarction (NSTEMI) and have reported contradicting results. Hypothesis: We performed a meta-analysis of all the available RCTs to date to determine the best strategy in NSTEMI. Methods: We performed a comprehensive search of PubMed, EMBASE, and Cochrane databases for all RCTs comparing an early versus delayed revascularization in NSTEMI. The primary endpoint was all-cause mortality. The secondary endpoints were re-infarction and refractory ischemia. We used the Paule-Mandel (PM) estimator of Tau with Knapp-Hartung adjustment to calculate relative risk (RR) with a 95% confidence interval (CI). Results: Thirteen RCTs were included in the final analysis. The median time between randomization and angiography ranged from 0.5 to 14 h in the early group and 18.3 to 86.0 h in the delayed group. There was no difference in mortality (5.7% vs 6.6%; RR 0.90; 95% CI 0.78-1.04; p = 0.83) (PANEL A) as well as rate of re-infarction (6.7% vs. 7.7%; RR 0.83; 95% CI 0.10-6.71; p = <0.001) (PANEL B) among both the strategy. However, early revascularization was associated with a reduction in refractory ischemia (4.8% vs 7.4%; RR 0.64; 95% CI 0.44-0.94; p=0.002) (PANEL C) Conclusions: Early revascularization for NSTEMI does not reduce the risk of mortality or re-infarction compared with delayed revascularization. Nonetheless, an early invasive approach does decrease the rate of refractory ischemia in NSTEMI.