NEW YORK (Reuters Health) – The likelihood of refractory ischemia developing in patients with non-ST-segment elevation acute coronary syndrome is reduced if they undergo early rather than deferred coronary revascularization. However, the strategy does not decrease the risk of major adverse cardiac events.

Those findings come from a meta-analysis reported by a Chinese group in the American Journal of Cardiology online August 29. The authors note that patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) make up the largest group undergoing coronary revascularization. However, the impact of early or deferred revascularization on clinical outcomes is not clear.

To look into this issue, Dr. Junbo Ge and colleagues with the Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University in Shanghai, identified 14 relevant trials and included five of them in a meta-analysis. The pooled data included 4155 patients with NSTE-ACS; 2153 underwent early intervention and 2002 underwent deferred intervention.

There was no significant difference between the early versus deferred groups in the incidence of death (risk ratio 0.88, p=0.47) or recurrent myocardial infarction (RR 0.92, p=0.58) at 30 days, the team found. Corresponding rates at 6 months were also not significantly different.

In addition, an apparent benefit of deferred intervention in terms of repeat revascularization disappeared after 6 months of follow-up, according to the report.

However, the occurrence of refractory ischemia, which predicted high risk for progression to MI, was significantly decreased with early revascularization (RR 0.47, p<0.01). Furthermore, there was a nonsignificant trend toward decreased risk of major bleeding with early intervention, Dr. Ge and colleagues report.

On that basis, they conclude that an early revascularization strategy that avoids prolonged anticoagulation “might be a preferred option for patients with NSTE-ACS when access to cardiac catheterization and revascularization capability is readily available.”

Reference:
Meta-Analysis of Early Versus Deferred Revascularization for Non–ST-Segment Elevation Acute Coronary Syndrome
Am J Cardiol 2011.