coronary disease, acute coronary syndrome, without ST elevation
DISEASE INTERVENTION COMPARISON RESULTS
N Engl J Med. 2001 Aug 16;345(7):494-502 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation The Use of
adenosine diphosphate (ADP) receptor inhibitors, clopidogrel, added to aspirin, combined anti-platelet therapy
As Treatment, Acute
Is better Than
aspirin alone
To reduce, at 1 year, ischemic events (cardiovascular death, myocardial infarction or stroke): 9.3% in intv VS 11.4% in ctrl. Increase major bleeds (3.7% in intv. VS 2.7% in ctrl.)
J Am Coll Cardiol. 2010 Mar 2;55(9):858-64 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation The Use of
early invasive strategy of coronary angiography and revascularization when feasible
As Treatment, Acute
Is equal Than
conservative strategy: coronary angiography and revascularization only if recurrent ischemia or on provocative testing
To modify at 5 years cumulative death or MI rates (22.3% early VS 18.1% conservative), or mortality.
JAMA. 2001 Nov 21; 286 (19):2405-12 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation The Use of
early invasive strategy of coronary angiography between 4 and 48 hours and revascularization when feasible
As Treatment, Acute
Is better Than
Conservative strategy: coronary angiography and revascularization only if recurrent ischemia at rest or on provocative testing
To reduce composite end point of death, MI, or rehospitalization for acute coronary syndrome at 6 months: 15.3% in intv. VS 25% in ctrl.
N Engl J Med. 2005 Sep 15;353(11):1095-104 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation The Use of
early invasive strategy of coronary angiography revascularization when feasible
As Treatment, Acute
Is equal Than
conservative strategy: coronary angiography and revascularization only if recurrent ischemia or on provocative testing
To reduce at 1 year a composite enpoint of death, nonfatal myocardial infarction, or rehospitalization for anginal symptoms: 22.7% in early invasive VS 21.2% with conservative strategy. Early invasive strategy associated more AMI but less rehospitalisations
Lancet. 2002 Jan 19;359(9302):189-98 Meta-Analysis
IN coronary disease, acute coronary syndrome, without ST elevation The Use of
glycoprotein IIb/IIIa inhibitors, anti-platelet
As Treatment, Acute
Is better Than
placebo
To reduce at 30 days death or myocardial infarction (10.8% in intv. VS 11.8% in ctrl.). Increase major bleeds (2,4% in intv. VS 1,4% in ctrl)
N Engl J Med. 2006 Apr 6;354(14):1464-76. Epub 2006 Mar 14 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation The Use of
pentasacharide analogues, fondaparinux (2.5 mg/d SC) for 6 days
As Treatment, Acute
Is equal Than
low molecular weight heparin (LMWH), enoxaparin 1 mg/Kg/12h
To reduce at 30 days bad outcome (death, reinfarction, or refractory ischemia): 8.0% fondaparinux VS 8.6% enoxaparin. Fondaparinux had fewer major haemorrhages: 3.1% VS 5.0% enoxaparin
JAMA. 2008 Jul 2;300(1):71-80 Meta-Analysis
IN coronary disease, acute coronary syndrome, without ST elevation, biomarkers positive The Use of
early invasive strategy of coronary angiography revascularization when feasible
As Treatment, Acute
Is better Than
conservative strategy
To reduce death, myocardial infarction or readmission: 21% early invasive strategy VS 25.5% conservative.