Meta-analysis of early versus deferred revascularization for non-ST-segment elevation acute coronary syndrome

Abstract

The impact of a coronary revascularization strategy (early or deferred) on clinical outcomes of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) has not been well established. The goal of this study was to systematically review randomized trials comparing early to deferred revascularization for NSTE-ACS. A systematic literature search of MEDLINE, ISI Web of Science, and Cochrane databases was conducted. Two reviewers independently determined the eligibility of clinical trials. Five trials with 4,155 patients were included for analysis. Meta-analysis showed that early revascularization produced no significant differences in the incidence of death (risk ratio [RR] 0.88, p = 0.47), recurrent myocardial infarction (RR 0.92, p = 0.58), and repeat revascularization compared to a deferred intervention. However, a significant decrease in refractory ischemia was observed in the early intervention group (RR 0.47, p <0.01), and the procedure also showed a tendency toward decreasing major bleeding events (RR 0.77, p = 0.08). According to stratification based on intervention era, extent of revascularization, and time of revascularization, subgroup analysis did not show between-group differences in all-cause mortality, recurrent myocardial infarction, and major bleeding events. Also, sensitivity analysis by alternatively using a random-effects model did not find any relevant influence on overall results in direction and magnitude. In conclusion, meta-analysis demonstrated that early coronary revascularization is feasible and safe for patients with NSTE-ACS, might markedly decrease the incidence of refractory ischemia, and appears to produce less bleeding.