Optimal Timing of Coronary Invasive Strategy in Non–ST-Segment Elevation Acute Coronary Syndromes


Angina.com: Author Interview: Dr Eliano Pio Navarese

Angina.com: What are the main findings of the study?

R: This is the most comprehensive source of evidence to date comparing early vs delayed coronary intervention in non-ST elevation myocardial infarction. In this study, early intervention leads to a nonsignificant mortality rate decrease compared with delayed intervention (NSTE-ACS).

Early intervention also is associated with a nonsignificant increase in myocardial infarction and decrease in major bleeding and statistically significant decrease in refractory ischemia during follow-up.

Strictly interpreted, the current meta-analysis indicates that early intervention offers little or no statistically significant clinical benefit compared with a delayed invasive approach.


R: The current study importantly shows in a systematic fashion that firm conclusions cannot be drawn in favor  of  or against an early invasive approach in the NSTE-ACS population.

This meta-analysis may inform current clinical practice showing that so far  the available evidence is insufficient to  support rushing  patients to early percutaneous coronary intervention(PCI) or coronary artery bypass grafting (CABG).

Angina.com What further research do you recommend as a result of your study?

R: A more definitive RCT, properly powered for mortality as the single end point, and related cost-effective analyses are warranted to quantify the potential survival benefits and assess the feasibility of an early approach in patients  with NSTE-ACS.


Optimal Timing of Coronary Invasive Strategy in Non–ST-Segment Elevation Acute Coronary Syndromes: A Systematic Review and Meta-analysis

Ann Intern Med. 2013 Feb 19;158(4):261-70. doi: 10.7326/0003-4819-158-4-201302190-00006.

Navarese EP, Gurbel PA, Andreotti F, Tantry U, Jeong YH, Kozinski M,Engstrøm T, Di Pasquale G, Kochman W, Ardissino D, Kedhi E, Stone GW, Kubica J.