Abstract 1757: Patient’s Risk Profile and Benefit from Invasive Approach in Initial Management of Non ST-Segment Elevation Acute Coronary Syndrome: A Meta-regression Analysis
Invasive strategy (IS) has been shown to exceed a conservative strategy (CS) in reducing myocardial infarction (MI), severe angina and re-hospitalization rate in patients with NSTEACS. Indeed, there is also a trend toward mortality reduction during the follow-up period with an IS. The aim of the current study was to analyse, by the use of randomized trials data if the risk profile of the NSTEACS patients influences the benefit of the IS over a CS in term of reduction of death (D) or D/MI at mid-long term follow-up (range 6–24 months). Eight randomized trials were identified from 1970 to 2005. A fixed effect-meta-regression analysis for 1) the log-odds ratio on death and 2) the log-odds ratio on D/MI against the odds of D/MI in the control group was made. IS was associated with a significant reduction in D/MI (12% vs 13.7%, OR [95% CI] = 0.86 [0.76 – 0.96], p = 0.009), but not in mortality (5.1% vs 5.5%, OR [95% CI] = 0.92 [0.77–1.09], p = 0.34). There was evidence of heterogeneity in the outcome mortality (P = 0.06) and the composite of D/MI (P = 0.01). Sensitivity analysis demonstrates that the source of heterogeneity was significantly related to the outlier VANQWISH trial. When the latter is removed from the analysis, IS was associated with a significant reduction of both D (3.9% vs 4.9%, p = 0.04, p heterogeneity = 0.35) and D/MI (10% vs 12.1%, p = 0.001, p heterogeneity = 0.07). Figure 1⇓ shows the relationship between the patient’s risk profile and the benefit from IS in term of both D and D/MI. The main finding of this meta-analysis is that when compared to a conservative treatment, the benefits of IS for the management of UA/NSTEMI in term of both mortality and D/MI are related to the patient’s risk profile.