Abstract 3472: Routine Invasive Strategy Does Not Reduce Major Cardiac Events In Patients With Acute Coronary Syndromes Without ST Elevation
The optimal management of acute coronary syndromes without ST elevation (ACS NSTE) is still controversial. This meta-analysis combined the results of randomized clinical trials, including the recent published ICTUS trial, to compare the efficacy of routine invasive strategy vs a “conservative” strategy to determine which therapy is most effective and safe. We identified 8 eligible randomized trials meeting inclusion criteria. Thus allowing a meta-analysis on 10415 patients for the effect on all major adverse clinical events (MACEs) combined for death, myocardial infarction and rehospitalization. Mean age ranged between 59 and 66 years, and men were predominantly enrolled. No difference between routine and selective invasive treatment was found in the mortality risk (RR=0.90; 95% CI=0.71–1.15; p=0.415), in the reduction of risk of non fatal MI (RR=0.86; 95% CI=0.68–1.09; p = 0.207), and in the composite outcome of death and non fatal MI (RR=0.88; 95% CI=0.71–1.09; p=0.246). In contrast, the routine invasive treatment significantly reduced by 20% the risk of rehospital-ization (RR=0.80; 95% CI=0.70 – 0.92; p=0.002), and considering the single trials, the rehospitalization was significantly reduced by a routine invasive strategy in the TIMI IIIB, FRISC II, TACTICS, RITA and ICTUS trials. However, a subgroup analysis for patients with age >65 years performed pooling the data from the TIMI IIIB, FRISC, TACTICS and ICTUS trials demonstrated a significant 24% reduction in the risk of death or non fatal MI for patients treated with the routine invasive strategy (RR=0.76; 95% CI=0.61– 0.93; p=0.008). Thus, in patients with ACS NSTE, a routine invasive strategy did not significantly affect major cardiovascular outcome compared to a “selectively” invasive strategy. Finally, a beneficial effect of a routine invasive approach in ACS NSTE was documented for the first time in elderly patients.