Early versus delayed percutaneous coronary intervention for patients with non‐ST segment elevation acute coronary syndrome: A meta‐analysis of randomized controlled clinical trials

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. Purpose: 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). Data Sources: Data were extracted from searches of MEDLINE (1990‐2010) and Google scholar and from scrutiny of abstract booklets from major cardiology meetings (1990‐2010). Study selection: Randomized clinical trials (RCTs) that included the composite endpoint of death and non‐fatal myocardial infarction (MI) at 30 days after PCI were considered. Data Extraction: 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. Data Synthesis: 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. © 2012 Wiley Periodicals, Inc.