Objectives: We aimed to determine the best time period for an early invasive intervention in non-ST elevation acute coronary syndrome (NSTEACS) patients.
Background: Studies assessing the timing of percutaneous coronary intervention (PCI) in patients with NSTEACS have failed to generate a consensus on when PCI should be performed in such patients.
Methods: Literature searches were conducted for randomized, controlled trials (RCTs) on NSTEACS from 1970 through September 2012. Patients were analyzed who were at moderate to high risk for NSTEACS and who underwent angiography within 96 hours. The major outcomes were the rate of death, recurrent myocardial infarction (re-MI), stroke, and major bleeding.
Results: Eight RCTs, which included 5761 patients, were eligible. There were no significant differences in the odds of death or stroke between time points. Conversely, patients undergoing angiography before 2 hours were associated with a higher rate of re-MI, compared with those undergoing angiography more than 2 hours later (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.53-3.02; P<.001; I² = 0%). Major bleeding events decreased only with angiography performed within 12 hours, compared to more than 12 hours (OR, 0.65; 95% CI, 0.44-0.96; P=.03; I² = 0%). Angiography before 2 hours was not associated with a lower rate of major bleeding compared with angiography after 2 hours (OR, 0.61; 95% CI, 0.28-1.30; P=.20; I² = 0%).
Conclusions: Angiography within 12 hours reduces the risk of major bleeding. There is no need to push for angiography within 2 hours.