Dharam J. Kumbhani, MD, SM; Anthony A. Bavry, MD, MPH
Potential Financial Conflicts of Interest: None disclosed.
Kumbhani DJ, Bavry AA. Possible Benefit to Survival from Early Invasive Strategies in Patients with Acute Coronary Syndromes. Ann Intern Med. 2008;148:883-884. doi: 10.7326/0003-4819-148-11-200806030-00014
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Published: Ann Intern Med. 2008;148(11):883-884.
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 6.5% in the conservative group (risk ratio, 0.75 [95% CI, 0.63 to 0.90]; P = 0.001), and the incidence of nonfatal myocardial infarction was 7.6% in the invasive group versus 9.1% in the conservative group (risk ratio, 0.83 [CI, 0.72 to 0.96]; P = 0.012) (2). Men and troponin-positive patients had the most benefit (3).
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