Acute coronary syndromes and myocardial infarction: Early invasive strategy using angiography and revascularization
DISEASE INTERVENTION COMPARISON RESULTS
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
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.
N Engl J Med. 1999 Aug 26;341(9):625-34 Randomized Controlled Trial
IN coronary disease, myocardial infarction, cardiogenic shock The Use of
early invasive strategy, early revascularization, angioplasty or surgical
As Treatment, Acute
Is better Than
conservative strategy: initial medical stabilization and selective late revascularization
To reduce mortality at 6 months: 50% with urgent revascularization vs. 63% conttrols
Circulation. 2010 Apr 6;121(13):1484-91 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
early treatment with primary percutaneous coronary intervention, angioplasty
As Treatment, Acute
Is better Than
early primary fibrinolysis
To reduce at 8 years reinfarction (13% angioplasty VS 18.5% fibrinolysis ) and mortality (27% angioplasty VS 33% fibrinolysis )
N Engl J Med. 2005 Dec 29;353(26):2758-68 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation, failed thrombolysis The Use of
rescue emergency angioplasty after failed thrombolytic therapy
As Treatment, Acute
Is better Than
repeated thrombolysis or conservative treatment
To reduce, at 6 months, cardiovascular events (composite of death, reinfarction, stroke, or severe heart failure): 15.4% with rescue angioplasty VS 31.3% with repeated thrombolysis and 29.1% with conservative treatment