title: Routine invasive versus selective invasive strategies for Non-ST-elevation acute coronary syndromes: An Updated meta-analysis of randomized trials.
abstract: OBJECTIVE
  To perform an updated systematic review comparing a routine invasive strategy with a selective invasive strategy for patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) in the era of stents and antiplatelet therapy.
  
  
  BACKGROUND
  Recent meta-analyses comparing both strategies have shown conflicting results.
  
  
  METHODS
  Electronic databases were searched for randomized trials that compared a routine invasive strategy (i.e., routine coronary angiography +/- revascularization) versus a selective invasive strategy (i.e., medical stabilization and coronary angiography +/- revascularization if objective evidence of ischemia or refractory ischemia) in patients with NSTE-ACS. Summary odds ratios (OR) were primarily constructed using Peto's model.
  
  
  RESULTS
  Twelve trials with 9,650 patients were included. Compared with a selective invasive strategy, a routine invasive strategy was associated with a reduction in the composite of all-cause mortality or myocardial infarction (MI) [OR: 0.86, 95% confidence interval (CI) 0.77-0.96] at a mean follow-up of 39 months, primarily due to a reduction in the risk of MI (OR: 0.78, 95% CI: 0.68-0.88). The risk of all-cause mortality was non-significantly reduced with a routine invasive strategy (OR: 0.88, 95% CI: 0.77-1.01). The risk of recurrent angina was reduced with a routine invasive strategy (OR: 0.55, 95% CI: 0.49-0.62), as well as the risk of future revascularization procedures (OR: 0.35, 95% CI: 0.30-0.39).
  
  
  CONCLUSIONS
  In patients with NSTE-ACS, a routine invasive strategy reduced the risk of ischemic events, including the risk of mortality or MI. Routine invasive therapy reduced the risk of recurrent angina and future revascularization procedures. © 2016 Wiley Periodicals, Inc.
authors: Department of Medicine, University of Florida, Gainesville, Florida.
authors: Islam Y
authors: http://orcid.org/0000-0001-9853-7591
authors: IY
authors: Elgendy
authors: Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Dharam J
authors: DJ
authors: Kumbhani
authors: Department of Medicine, University of Florida, Gainesville, Florida.
authors: Ahmed N
authors: AN
authors: Mahmoud
authors: Department of Medicine, University of Florida, Gainesville, Florida.
authors: Xuerong
authors: X
authors: Wen
authors: Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts.
authors: Deepak L
authors: DL
authors: Bhatt
authors: Department of Medicine, University of Florida, Gainesville, Florida.|North Florida/South Georgia Veterans Health System, Gainesville, Florida.
authors: Anthony A
authors: AA
authors: Bavry
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D017023:Coronary Angiography; D006801:Humans; D009204:Myocardial Revascularization; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D016032:Randomized Controlled Trials as Topic
keywords: acute coronary syndrome; meta-analysis; mortality; myocardial infarction; revascularization