title: [Evaluation of early invasive or initially conservative strategies in patients with non-ST-segment elevation acute coronary syndrome at intermediate or high risk].
abstract: OBJECTIVE
  To demonstrate the effect of early strategies and revascularization patterns on in-hospital major adverse cardiac events (MACE) in patients with non-ST-segment elevation acute coronary syndrome (ACS) at intermediate or high risk.
  
  
  METHODS
  910 Patients with non-ST-segment elevation ACS at intermediate or high risk were divided into either early invasive (n = 237) or initially conservative (n = 673) group according to whether or when coronary angiography (CAG) was performed after admission (<or= 48 h or > 48 h) in order to demonstrate the impact of early strategies and revascularization patterns on in-hospital MACE events (death, new-onset myocardial infarction or repeat revascularization).
  
  
  RESULTS
  Compared with those of the initially conservative group, patients in the early invasive group had a shorter hospital stay and increased rate of MACE (6.3% vs 2.5%, OR 0.384, 95% CI 0.188 - 0.781, P = 0.006) or new-onset myocardial infarction (4.6% vs 0.9%, OR 0.185, 95% CI 0.068 - 0.505, P = 0.001), which was partly due to increased procedures of revascularization (86.9% vs 67.5%, P < 0.001). No differences were found among in-hospital mortality or rate of repeat revascularization between the two groups. During subgroup analysis, patients receiving PCI in the early invasive or initially conservative group had comparable rates of new-onset myocardial infarction, repeat revascularization or MACE events, whereas patients receiving CABG in the early invasive group had a higher rate of new-onset myocardial infarctions than those in the initially conservative group (7.5% vs 1.8%, P = 0.027).
  
  
  CONCLUSIONS
  An early invasive strategy in patients with non-ST-segment elevation ACS had comparable in-hospital mortality and higher rate of in-hospital myocardial infarction compared with an initially conservative strategy, an early invasive strategy with PCI seems safe and feasible without increased risk of adverse clinical events. The impact of early CABG on in-hospital adverse events warrants further investigation.
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Sciences, Beijing 100029, China.
authors.forename: Shao-ping
authors.initials: SP
authors.lastname: Nie
authors.forename: Chang-sheng
authors.initials: CS
authors.lastname: Ma
authors.forename: Qiang
authors.initials: Q
authors.lastname: Lü
authors.forename: Yin
authors.initials: Y
authors.lastname: Zhang
authors.forename: Xin
authors.initials: X
authors.lastname: Du
authors.forename: Jun-ping
authors.initials: JP
authors.lastname: Kang
authors.forename: Peng
authors.initials: P
authors.lastname: Hao
authors.forename: Tong
authors.initials: T
authors.lastname: Liu
authors.forename: Su
authors.initials: S
authors.lastname: Wang
authors.forename: Jian-zeng
authors.initials: JZ
authors.lastname: Dong
authors.forename: Xiao-hui
authors.initials: XH
authors.lastname: Liu
authors.forename: Xue-si
authors.initials: XS
authors.lastname: Wu
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D009204:Myocardial Revascularization