Abdelaziz Ahmed, Elsayed Hanaa, Atta Karim, Mechi Ahmed, Kadhim Hallas, Aboutaleb Aya Moustafa, Elaraby Ahmed, Ellabban Mohamed Hatem, Eid Mahmoud, AboElfarh Hadeer Elsaeed, Ibrahim Rahma AbdElfattah, Zawaneh Emad Addin, Ezzat Mahmoud, Abdelaziz Mohamed, Hafez Abdelrahman, Mahmoud Ahmed, Ghaith Hazem S, Suppah Mustafa
Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Int J Cardiol. 2024 Apr 1;400:131774. doi: 10.1016/j.ijcard.2024.131774. Epub 2024 Jan 10.
Invasive revascularization is recommended for cohorts of patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation acute coronary syndrome (NSTE-ACS). However, the optimal timing of invasive revascularization is still controversial and no defined consensus is established. We aim to give a comprehensive appraisal on the optimal timing of invasive strategy in the heterogenous population of ACS.
Relevant studies were assessed through PubMed, Scopus, Web of science, and Cochrane Library from inception until April 2023. Major adverse cardiovascular events (MACE) and all-cause mortality were our primary outcomes of interest, other secondary outcomes were cardiac death, TVR, MI, repeat revascularization, recurrent ischemia, and major bleeding. The data was pooled as odds ratio (OR) with its 95% confidence interval (CI) in a random effect model using STATA 17 MP.
A total of 26 studies comprising 21,443 patients were included in the analysis. Early intervention was favor to decrease all-cause mortality (OR = 0.79, 95% CI: 0.64 to 0.98, p = 0.03), when compared to delayed intervention. Subgroup analysis showed that early intervention was significantly associated with all-cause mortality reduction in only NSTE-ACS (OR = 0.83, 95% CI [0.7 to 0.99], p = 0.04). However, there was no significant difference between early and delayed intervention in terms of MACE, cardiac death, TVR, MI, repeat revascularization, recurrent ischemia, and major bleeding.
An early intervention was associated with lower mortality rates compared to delayed intervention in NSTE-ACS with no significant difference in other clinical outcomes. PROSPERO registration: CRD42023415574.
对于ST段抬高型心肌梗死（STEMI）和非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者群体，推荐进行有创血管重建术。然而，有创血管重建术的最佳时机仍存在争议，尚未达成明确共识。我们旨在对ACS异质性人群中侵入性策略的最佳时机进行全面评估。
从数据库建立至2023年4月，通过PubMed、Scopus、科学网和考克兰图书馆对相关研究进行评估。主要不良心血管事件（MACE）和全因死亡率是我们感兴趣的主要结局，其他次要结局包括心源性死亡、靶血管重建（TVR）、心肌梗死（MI）、再次血管重建、复发缺血和大出血。使用STATA 17 MP软件，在随机效应模型中汇总数据为比值比（OR）及其95%置信区间（CI）。
共有26项研究（包括21443例患者）纳入分析。与延迟干预相比，早期干预有利于降低全因死亡率（OR = 0.79，95% CI：0.64至0.98，p = 0.03）。亚组分析显示，仅在NSTE-ACS中，早期干预与全因死亡率降低显著相关（OR = 0.83，95% CI [0.7至0.99]，p = 0.04）。然而，在MACE、心源性死亡、TVR、MI、再次血管重建、复发缺血和大出血方面，早期和延迟干预之间无显著差异。
与延迟干预相比，早期干预与NSTE-ACS患者较低的死亡率相关，在其他临床结局方面无显著差异。国际前瞻性系统评价注册库（PROSPERO）注册号：CRD42023415574。
