Optimal timing of coronary angiography and potential intervention in non-ST-elevation acute coronary syndromes

Demosthenes G. Katritsis, George C.M. Siontis, Adnan Kastrati, Arnoud W.J. Vant Hof, Franz Josef Neumann, Konstantinos C.M. Siontis, John P.A. Ioannidis

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174 Scopus citations

Abstract

Aims An invasive approach is superior to medical management for the treatment of patients with acute coronary syndromes without ST-segment elevation (NSTE-ACS), but the optimal timing of coronary angiography and subsequent intervention, if indicated, has not been settled. Methods and resultsWe conducted a meta-analysis of randomized trials addressing the optimal timing (early vs. delayed) of coronary angiography in NSTE-ACS. Four trials with 4013 patients were eligible (ABOARD, ELISA, ISAR-COOL, TIMACS), and data for longer follow-up periods than those published became available for this meta-analysis by the ELISA and ISAR-COOL investigators. The median time from admission or randomization to coronary angiography ranged from 1.16 to 14 h in the early and 20.886 h in the delayed strategy group. No statistically significant difference of risk of death [random effects risk ratio (RR) 0.85, 95 confidence interval (CI) 0.641.11] or myocardial infarction (MI) (RR 0.94, 95 CI 0.611.45) was detected between the two strategies. Early intervention significantly reduced the risk for recurrent ischaemia (RR 0.59, 95 CI 0.380.92, P 0.02) and the duration of hospital stay (by 28, 95 CI 2235, P < 0.001). Furthermore, decreased major bleeding events (RR 0.78, 95 CI 0.571.07, P 0.13), and less major events (death, MI, or stroke) (RR 0.91, 95 CI 0.821.01, P 0.09) were observed with the early strategy but these differences were not nominally significant. Conclusion Early coronary angiography and potential intervention reduces the risk of recurrent ischaemia, and shortens hospital stay in patients with NSTE-ACS. Published on behalf of the European Society of Cardiology. All rights reserved.

Original languageEnglish
Pages (from-to)32-40
Number of pages9
JournalEuropean Heart Journal
Volume32
Issue number1
DOIs
StatePublished - Jan 2011

Keywords

  • Angiography
  • Meta-analysis
  • NSTE-ACS
  • Timing

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