Conflict of interest: Nothing to report.
Coronary Artery Disease
Early versus delayed percutaneous coronary intervention for patients with non-ST segment elevation acute coronary syndrome: A meta-analysis of randomized controlled clinical trials
Article first published online: 24 MAY 2012
Copyright © 2012 Wiley Periodicals, Inc.
Catheterization and Cardiovascular Interventions
Volume 81, Issue 2, pages 223–231, February 2013
How to Cite
Rajpurohit, N., Garg, N., Garg, R., Choudhary, A., Fresen, J., Boren, S., Dellsperger, K. C., Webel, R., Aggarwal, K. and Alpert, M. A. (2013), Early versus delayed percutaneous coronary intervention for patients with non-ST segment elevation acute coronary syndrome: A meta-analysis of randomized controlled clinical trials. Cathet. Cardiovasc. Intervent., 81: 223–231. doi: 10.1002/ccd.24439
- Issue published online: 19 FEB 2013
- Article first published online: 24 MAY 2012
- Accepted manuscript online: 4 APR 2012 06:18AM EST
- Manuscript Revised: 22 JAN 2012
- Manuscript Received: 28 AUG 2011
- Manuscript Accepted: 27 MAR 2011
Erratum: Early versus delayed percutaneous coronary intervention for patients with non-ST segment elevation acute coronary syndrome: A meta-analysis of randomized controlled clinical trials 2013;81:223. DOI: 10.1002/ccd.24439
Vol. 81, Issue 7, 1255, Article first published online: 24 MAY 2013
- acute coronary syndrome;
- percutaneous coronary intervention;
Background: Studies assessing the timing of percutaneous coronary interventions (PCI) in patients with Non-ST segment elevation Acute Coronary Syndromes (NSTE-ACS) have failed to generate a consensus on how early PCI should be performed in such patients. Purpose: This meta-analysis compares clinical outcomes at 30 days in NSTE-ACS patients undergoing PCI within 24 hours of presentation (early PCI) with those receiving PCI more than 24 hours after presentation (delayed PCI). Data Sources: Data were extracted from searches of MEDLINE (1990-2010) and Google scholar and from scrutiny of abstract booklets from major cardiology meetings (1990-2010). Study selection: Randomized clinical trials (RCTs) that included the composite endpoint of death and non-fatal myocardial infarction (MI) at 30 days after PCI were considered. Data Extraction: Two independent reviewers extracted data using standard forms. The effects of early and delayed PCI were analyzed by calculating pooled estimates for death, non-fatal MI, bleeding, repeat revascularization and the composite endpoint of death or non-fatal MI at 30 days. Univariate analysis of each of these variables was used to create odds ratios. Data Synthesis: Seven studies with a total of 13,762 patients met the inclusion criteria. There was no significant difference in the odds of the composite endpoint of death or non-fatal MI at 30 days between patients undergoing early PCI and those receiving delayed PCI (OR-0.83, 95%CI 0.62-1.10). Patients receiving delayed PCI experienced a 33% reduction in the odds of repeat revascularization at 30 days compared to those undergoing early PCI (OR-1.33, 95%CI 1.14-1.56, P=0.0004).Conversely, patients undergoing early PCI experienced lower odds of bleeding than those receiving delayed PCI (OR-0.76, 95%CI 0.63-0.91, P = 0.0003). Conclusions: In NSTE-ACS patients early PCI doesn't reduce the odds of the composite endpoint of death or non-fatal MI at 30 day. This strategy is associated with lower odds of bleeding and higher odds of repeat revascularization at 30 days than a strategy of delayed PCI. © 2012 Wiley Periodicals, Inc.