title: Early versus delayed percutaneous coronary intervention for patients with non-ST segment elevation acute coronary syndrome: a meta-analysis of randomized controlled clinical trials.
abstract: BACKGROUND
  Studies assessing the timing of percutaneous coronary interventions (PCI) in patients with Non-ST segment elevation Acute Coronary Syndromes (NSTE-ACS) have failed to generate a consensus on how early PCI should be performed in such patients.
  
  
  OBJECTIVE
  This meta-analysis compares clinical outcomes at 30 days in NSTE-ACS patients undergoing PCI within 24 hours of presentation (early PCI) with those receiving PCI more than 24 hours after presentation (delayed PCI).
  
  
  METHODS
  Data were extracted from searches of MEDLINE (1990-2010) and Google scholar and from scrutiny of abstract booklets from major cardiology meetings (1990-2010).
  
  
  METHODS
  Randomized clinical trials (RCTs) that included the composite endpoint of death and non-fatal myocardial infarction (MI) at 30 days after PCI were considered.
  
  
  METHODS
  Two independent reviewers extracted data using standard forms. The effects of early and delayed PCI were analyzed by calculating pooled estimates for death, non-fatal MI, bleeding, repeat revascularization and the composite endpoint of death or non-fatal MI at 30 days. Univariate analysis of each of these variables was used to create odds ratios.
  
  
  RESULTS
  Seven studies with a total of 13,762 patients met the inclusion criteria. There was no significant difference in the odds of the composite endpoint of death or non-fatal MI at 30 days between patients undergoing early PCI and those receiving delayed PCI (OR-0.83, 95%CI 0.62-1.10). Patients receiving delayed PCI experienced a 33% reduction in the odds of repeat revascularization at 30 days compared to those undergoing early PCI (OR-1.33, 95%CI 1.14-1.56, P=0.0004).Conversely, patients undergoing early PCI experienced lower odds of bleeding than those receiving delayed PCI (OR-0.76, 95%CI 0.63-0.91, P = 0.0003).
  
  
  CONCLUSIONS
  In NSTE-ACS patients early PCI doesn't reduce the odds of the composite endpoint of death or non-fatal MI at 30 day. This strategy is associated with lower odds of bleeding and higher odds of repeat revascularization at 30 days than a strategy of delayed PCI.
authors.affiliation: Department of Internal Medicine, University of Missouri, Columbia, Missouri 65212, USA. lakshya.naveen@gmail.com
authors.forename: Naveen
authors.initials: N
authors.lastname: Rajpurohit
authors.forename: Nadish
authors.initials: N
authors.lastname: Garg
authors.forename: Rajeev
authors.initials: R
authors.lastname: Garg
authors.forename: Abhishek
authors.initials: A
authors.lastname: Choudhary
authors.forename: John
authors.initials: J
authors.lastname: Fresen
authors.forename: Sue
authors.initials: S
authors.lastname: Boren
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Dellsperger
authors.forename: Richard
authors.initials: R
authors.lastname: Webel
authors.forename: Kul
authors.initials: K
authors.lastname: Aggarwal
authors.forename: Martin A
authors.initials: MA
authors.lastname: Alpert
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy*; D000368:Aged; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome