Abstract
Purpose
Patients with unstable angina or non-ST-segment elevation myocardial infarction (MI)
may be managed with either an “invasive” or “conservative” strategy. It is unclear
which of these strategies is superior.
Methods
We identified studies with MEDLINE and EMBASE searches (1966-September 2003) and by
reviewing reference lists. Studies were included if they were randomized controlled
trials comparing management strategies for patients in the early post-unstable angina/non-ST-segment
elevation MI period and had follow-up data for at least 3 months.
Results
Seven trials that randomized a total of 9212 patients were included. The pooled odds
ratio (OR) for all-cause mortality was 0.96 (95% confidence interval [CI]: 0.72 to
1.27). The occurrence of fatal or nonfatal re-infarction was reduced with an invasive
strategy (OR 0.73; 95% CI: 0.61 to 0.88) as was readmission to hospital (OR 0.67;
95% CI: 0.48 to 0.94). The endpoints of nonfatal MI and the composite of death or
nonfatal MI showed nonsignificant trends favoring an invasive strategy. Trials that
included a higher proportion of patients with ST-segment depression on admission and
trials in which a larger proportion of patients underwent revascularization showed
a greater magnitude of benefit for an invasive strategy.
Conclusion
For patients with unstable angina/non-ST-segment elevation MI, an invasive strategy
reduces rates of fatal or nonfatal re-infarction and hospital readmission, but not
all-cause mortality, when compared with a noninvasive strategy. These results suggest
that an invasive management strategy should be considered for all patients with unstable
angina/non-ST-segment elevation MI and perhaps in particular those with ST-segment
depression.
Keywords
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© 2005 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
