Acute coronary syndromes and myocardial infarction: Routine invasive strategy versus conservative symptom-driven strategy
DISEASE INTERVENTION COMPARISON RESULTS
Lancet. 2000 Jul 1;356(9223):9-16 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, unstable angina The Use of
routine invasive strategy (angiography and revascularization), first 10 days
As Treatment, Acute
Is better Than
non invasive startegy
To reduce, 1 year later, death (2.2% invasive VS 3.2% conservative) and reinfarction (9% invasive VS 12% conservative)
Lancet. 2006 Sep 16;368(9540):998-1004 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST-segment elevation The Use of
early invasive strategy with coronary angiography and, if appropriate, revascularisation within 7 days
As Treatment, Acute
Is better Than
conservative strategy: non-invasive primarily medical strategy
To reduce at 5 years death or myocardial infarction: 19.9% invasive strategy VS 24.5% conservative strategy.
Ann Intern Med. 2008 Feb 5;148(3):186-96 Systematic Review
IN coronary disease, acute coronary syndrome, without ST-segment elevation The Use of
routine invasive strategy (angiography and revascularization)
As Treatment, Acute
Is equal Than
conservative strategy (ischaemia- or symptom-driven angiography)
To reduce mortality (RR 0.90, 0.80 to 1.14) or re-infarction (RR 0.86, 0.68 to 1.08)
Eur Heart J. 2012 Jan;33(1):51-60 Randomized Controlled Trial
IN coronary disease, acute coronary syndrome, without ST-segment elevation, women The Use of
routine invasive strategy (angiography and revascularization)
As Treatment, Acute
Is worse Than
conservative strategy (ischaemia- or symptom-driven angiography)
To routine invasive strategy increased death at 1 year in women (8.8% VS 1.1% in the RCT and OR 1.51 in the meta-analysis) and did NOT modify MI and stroke rates. Results in men are not always extapolable to women
Eur Heart J. 2004 Dec;25(24):2187-94 Randomized Controlled Trial
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
late (2 - 15 days after MI) routine percutaneous revascularization
As Treatment, Acute
Is equal Than
medical treatment alone, if patient stable
To reduce cardivascular events (composite of cardiac death, non-fatal MI, or ventricular tachyarrhythmia) at 3 years: 7.3% revascularization VS 8.7% controls
N Engl J Med. 2006 Dec 7;355(23):2395-407 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, total occlusion of the infarct-related artery The Use of
routine (3 to 28 days) invasive strategy, percutaneous coronary stenting
As Treatment, Acute
Is equal Than
optimal medical therapy and percutaneous intervention only if needed
To reduce, at 4 year, death or myocardial reinfarction: 17.2% invasive group VS 15.6% medical therapy
Lancet. 2005 Sep 10;366(9489):914-20 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, without ST-segment elevation The Use of
routine invasive strategy (angiography and revascularization)
As Treatment, Acute
Is better Than
conservative strategy (ischaemia- or symptom-driven angiography)
To reduce at 5 years: death or non-fatal myocardial infarction (16.6% in invasive VS 20% in conservative strategy). A trend to reduce death but not significant.
Am J Med. 2005 May;118(5):465-74 Meta-Analysis
IN coronary disease, myocardial infarction, without ST-segment elevation, unstable angina The Use of
routine invasive strategy
As Treatment, Acute
Is better Than
conservative strategy
To reduce rates of fatal or nonfatal re-infarction and hospital readmission, but not all-cause mortality.