Possible Benefit to Survival from Early Invasive Strategies in Patients with Acute Coronary Syndromes
Authors: Dharam J. Kumbhani, Anthony A. Bavry
Journal: Annals of Internal Medicine (2008)

Letters3 June 2008Possible Benefit to Survival from Early Invasive Strategies in Patients with Acute Coronary SyndromesDharam J. Kumbhani, MD, SM and Anthony A. Bavry, MD, MPHDharam J. Kumbhani, MD, SMFrom The Cleveland Clinic, Cleveland, OH 44195.Search for more papers by this author and Anthony A. Bavry, MD, MPHFrom The Cleveland Clinic, Cleveland, OH 44195.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-148-11-200806030-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In their systematic review (1), Qayyum and colleagues report that there is no mortality benefit or reduction in nonfatal myocardial infarction from an early invasive strategy compared with conservative management for patients with non–ST-segment elevation acute coronary syndromes. We conducted 2 systematic reviews on this topic (2, 3) and demonstrated a statistically significant improvement in mortality and nonfatal myocardial infarction in the same population over a mean follow-up of 2 years. Specifically, in an analysis of 7 trials with 8375 patients, we noted that the incidence of all-cause mortality was 4.9% in the early invasive group versus ...References1. Qayyum R, Khalid MR, Adomaityte J, Papadakos SP, Messineo FC. Systematic review: comparing routine and selective invasive strategies for the acute coronary syndrome. Ann Intern Med. 2008;148:186-96. [PMID: 18252682] LinkGoogle Scholar2. Bavry AA, Kumbhani DJ, Rassi AN, Bhatt DL, Askari AT. Benefit of early invasive therapy in acute coronary syndromes: a meta-analysis of contemporary randomized clinical trials. J Am Coll Cardiol. 2006;48:1319-25. [PMID: 17010789] CrossrefMedlineGoogle Scholar3. Bavry AA, Kumbhani DJ, Quiroz R, Ramchandani SR, Kenchaiah S, Antman EM. Invasive therapy along with glycoprotein IIb/IIIa inhibitors and intracoronary stents improves survival in non-ST-segment elevation acute coronary syndromes: a meta-analysis and review of the literature. Am J Cardiol. 2004;93:830. [PMID: 15050484] CrossrefMedlineGoogle Scholar4. Karvouni E, Katritsis DG, Ioannidis JP. Intravenous glycoprotein IIb/IIIa receptor antagonists reduce mortality after percutaneous coronary interventions. J Am Coll Cardiol. 2003;41:26-32. [PMID: 12570940] CrossrefMedlineGoogle Scholar5. Biondi-Zoccai GG, Abbate A, Agostoni P, Testa L, Burzotta F, Lotrionte M, et al. Long-term benefits of an early invasive management in acute coronary syndromes depend on intracoronary stenting and aggressive antiplatelet treatment: a metaregression. Am Heart J. 2005;149:504-11. [PMID: 15864240] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Dharam J. Kumbhani, MD, SM; Anthony A. Bavry, MD, MPHAffiliations: From The Cleveland Clinic, Cleveland, OH 44195.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSystematic Review: Comparing Routine and Selective Invasive Strategies for the Acute Coronary Syndrome Rehan Qayyum , M. Rizwan Khalid , Jurga Adomaityte , Stylianos P. Papadakos , and Frank C. Messineo Possible Benefit to Survival from Early Invasive Strategies in Patients with Acute Coronary Syndromes Rehan Qayyum , Jurga Adomaityte , and M. Rizwan Khalid Metrics 3 June 2008Volume 148, Issue 11Page: 883-884KeywordsAcute coronary syndromeConflicts of interestGlycoproteinsHospital medicineMortalityMyocardial infarctionPercutaneous coronary interventionRisk ratioStent implantationSystematic reviews ePublished: 3 June 2008 Issue Published: 3 June 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...