1. Home>
2. Specialties>
3. Cardiology>
4. Summary and Comment

Routine Invasive Therapy for UA/NSTEMI

These researchers synthesized data from seven randomized trials of unstable angina/non–ST-segment–elevation MI (UA/NSTEMI) in which a routine invasive strategy (referral for angiography and, when appropriate, revascularization) was compared with a selective invasive strategy (initial medical treatment and revascularization only for recurrent symptoms or evidence of inducible ischemia). The trials involved 9212 patients (mean age, 62; 69% men; 19% with diabetes) and had a mean follow-up of 17 months.

Revascularization was performed in 58% of the routine-intervention group and 24% of the selective-intervention group during the initial hospitalization and in 64% and 42%, respectively, by the end of follow-up. Compared with the selective-invasive strategy, the routine-invasive strategy was associated with significantly higher rates of death (1.8% vs. 1.1%) and death or MI (5.2% vs. 3.8%) during the initial hospitalization. However, by the end of follow-up, the routine-invasive strategy was associated with a slightly lower rate of death (5.5% vs. 6.0%) and significantly lower rates of death or MI (12.2% vs. 14.4%), rehospitalization, and angina frequency. This strategy’s long-term benefit was most evident in patients with positive cardiac biomarkers, including troponin.

Comment: This meta-analysis documents long-term benefits of a routine invasive strategy in UA/NSTEMI patients. However, we still need effective means of minimizing the early mortality hazard and maximizing the late benefit. Toward that end, an editorialist emphasizes using proven therapies (e.g., adjunctive pharmacologic agents) and focusing on the highest-risk patients, who derive the greatest long-term benefits.

— Howard C. Herrmann, MD

Published in Journal Watch Cardiology July 29, 2005

Citation(s):

Mehta SR et al. Routine vs selective invasive strategies in patients with acute coronary syndromes: A collaborative meta-analysis of randomized trials. JAMA 2005 Jun 15; 293:2908-17.

• Original article (Subscription may be required)
• Medline abstract (Free)

Bhatt DL. To cath or not to cath: That is no longer the question. JAMA 2005 Jun 15; 293:2935-7.

• Original article (Subscription may be required)
• Medline abstract (Free)