Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: a meta-analysis of randomised trials

@article{Jobs2017OptimalTO,
  title={Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: a meta-analysis of randomised trials},
  author={Alexander Jobs and Shamir R. Mehta and Gilles Montalescot and Eric Vicaut and Arnoud WJ van’t Hof and Erik A Badings and Franz-Josef Neumann and Adnan Kastrati and Alessandro Sciahbasi and Paul-Georges Reuter and Fr{\'e}d{\'e}ric Lapostolle and Aleksandra Milo{\vs}evi{\'c} and Goran Stankovi{\'c} and Dejan Milasinovic and Reinhard Vonthein and Steffen Desch and Holger Thiele},
  journal={The Lancet},
  year={2017},
  volume={390},
  pages={737-746}
}

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References

SHOWING 1-10 OF 40 REFERENCES
Optimal Timing of Coronary Invasive Strategy in Non–ST-Segment Elevation Acute Coronary Syndromes
TLDR
There is insufficient evidence either in favor of or against an early invasive approach in the NSTE-ACS population, and a more definitive RCT is warranted to guide clinical practice.
Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction: a meta-analysis.
TLDR
In NSTE ACS, an invasive strategy has a comparable benefit in men and high-risk women for reducing the composite end point of death, MI, or rehospitalization with ACS, and evidence supporting the new guideline recommendation for a conservative strategy in low- risk women is provided.
The impact of increased age on outcome from a strategy of early invasive management and revascularisation in patients with acute coronary syndromes: retrospective analysis study from the ACACIA registry
TLDR
Following presentation with ACS, elderly patients are less likely to receive evidence-based medical therapies, to be considered for an early invasive strategy and be revascularised, and the absolute accrued benefit appears to be higher in elderly patients.
Early versus delayed percutaneous coronary intervention for patients with non‐ST segment elevation acute coronary syndrome: A meta‐analysis of randomized controlled clinical trials
  • Naveen Rajpurohit, N. Garg, M. Alpert
  • Medicine
    Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
  • 2013
TLDR
In NSTE‐ACS patients early PCI doesn't reduce the odds of the composite endpoint of death or non‐fatal MI at 30 day, and this strategy is associated with lower odds of bleeding and higher odds of repeat revascularization at 30 days than a strategy of delayed PCI.
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