Benefit Of Early Invasive Therapy In Unstable Angina And Non-st-elevation Myocardial Infarction: A Systematic Review

Objective: To determine the benefits of an invasive compared to a conservative strategy for treating UA/NSTEMI. Methods: We searched The Cochrane Library (Issue 4. 2009), MEDLINE (1996 to September 2009), EMBASE (1974 to September 2009), CBM (1989 to 2009), CNKI (1997 to 2009), VIP (1989 to 2009). The quality of included studies was critically evaluated. Data analyses were performed with The Cochrane Collabora- tion's Revman 5.0 software. Results: Six trials were excluded from review according to criteria. Six randomized controlled trials with total 10825 patients met the included criteria. The meta-analysis showed the incidence of all-cause mortality at follow-up was lower in the early invasive group compared with the conservative group [risk ratio (RR)=0.78, 95% confidence interval [CI] 0.65 to 0.93, P=0.006]; According to Sensitivity Analysis, myocardial infarction were significantly decreased by an invasive strategy with relative risk of 0.76 (95% CI 0.65 to 0.89); there was a reduction in rehospitalization for unstable angina[risk ratio (RR)=0.66, 95% confidence interval [CI] 0.60 to 0.72, P<0.00001]; The invasive strategy was associated with a two-fold increase in the relative risk of invasive-procedure- related myocardial infarction (as variably defined) and a 1.52-fold increase in the relative risk of bleeding. Conclusion: An early invasive strategy is preferable to a conservative strategy in the treatment of UA/NSTEMI. To avoid complications, indications of interventional therapy must be obeyed.